Adachi Nobuo, Ochi Mitsuo, Uchio Yuji, Sakai Yasuo, Kuriwaka Masakazu, Fujihara Atsushi
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan.
Arch Orthop Trauma Surg. 2003 Nov;123(9):460-5. doi: 10.1007/s00402-003-0572-2. Epub 2003 Aug 14.
Anterior cruciate ligament (ACL) reconstruction using hamstring tendons has recently received attention because of less donor site morbidity. It has been reported that harvesting hamstring tendons has little effect on postoperative hamstring muscle performance based on the peak torque value of the hamstring strength. However, recent studies have clarified some adverse effects of harvesting hamstring tendons. There is still argument about the influences of harvesting hamstring tendons on postoperative hamstring muscle performance. The purpose of this study was to evaluate the postoperative hamstring muscle performance measured by various parameters after harvesting hamstring tendons for ACL reconstruction.
We evaluated the postoperative hamstring muscle performance after harvesting hamstring tendons in 58 patients who underwent ACL reconstruction. We assessed peak torque value, total work, and peak torque angle in the isokinetic hamstring strength test and active knee flexion angle. We classified the patients into three groups according to the type of hamstring used for ACL reconstruction: 1) the autologous semitendinosus tendon (ST); 2) the autologous ST and the gracilis tendon, which were harvested from the ipsilateral knees; and 3) allogeneic fascia lata.
This study clearly demonstrated that the peak torque value and total work in the patients in each group compared to preoperative normal knees were not statistically different; however, the more hamstring tendons were harvested, the more loss of active knee flexion angle was observed and the more the peak torque angle was shifted to a shallow angle, suggesting that the hamstring strength might be weaker at the deep flexion angle.
Physicians should recognize that the ACL reconstruction using autologous hamstring tendons is not appropriate for sportsmen or women who are required to flex their knees deeply or powerfully in their performance.
由于供区并发症较少，使用腘绳肌腱进行前交叉韧带（ACL）重建近来受到关注。据报道，基于腘绳肌力量的峰值扭矩值，获取腘绳肌腱对术后腘绳肌功能影响不大。然而，近期研究已阐明获取腘绳肌腱的一些不良影响。关于获取腘绳肌腱对术后腘绳肌功能的影响仍存在争议。本研究的目的是评估在为ACL重建获取腘绳肌腱后，通过各种参数测量的术后腘绳肌功能。
我们评估了58例行ACL重建的患者在获取腘绳肌腱后的术后腘绳肌功能。我们在等速腘绳肌力量测试中评估了峰值扭矩值、总功和峰值扭矩角度以及主动膝关节屈曲角度。我们根据用于ACL重建的腘绳肌类型将患者分为三组：1）自体半腱肌腱（ST）；2）从同侧膝关节获取的自体ST和股薄肌腱；3）异体阔筋膜。
本研究清楚地表明，与术前正常膝关节相比，每组患者的峰值扭矩值和总功无统计学差异；然而，获取的腘绳肌腱越多，观察到的主动膝关节屈曲角度损失就越多，且峰值扭矩角度越向浅角度偏移，这表明在深屈曲角度时腘绳肌力量可能较弱。
医生应认识到，对于在运动中需要深度或强力屈曲膝关节的运动员，使用自体腘绳肌腱进行ACL重建并不合适。
