Gobbi Alberto, Tuy Benjamin, Mahajan Sanjeev, Panuncialman Ian
Orthopaedic Arthroscopic Surgery International, Milano, Italy.
Arthroscopy. 2003 Sep;19(7):691-9. doi: 10.1016/s0749-8063(03)00685-6.
The hypothesis of our study was that a quadrupled bone-semitendinosus (STB) graft could provide a clinically stable construct, allow recovery of normal limb strength, give high patient satisfaction with early return to active sports, and involve low donor-site morbidity.
Outcomes study.
Anterior cruciate ligament (ACL) reconstruction with an STB graft was performed on 80 athletes with isolated ACL injury from January 1996 to December 1999. Femoral fixation was obtained with EndoButton (Smith & Nephew, Andover, MA) and tibial fixation with Fastlok (Neoligaments, Leeds, England). At a mean follow-up time of 36 months (range, 24-52 months), patients were evaluated using standard knee scores (Noyes, Lysholm, Tegner, and International Knee Documentation Committee [IKDC] rating) and functional strength tests; postoperative pain rating; knee radiographs performed after surgery and at final follow-up; magnetic resonance imaging (MRI) at 3 to 6 months; isokinetic flexion-extension and internal-external rotation tests at 3, 6, and 12 months; and computed laxity analysis at final evaluation.
At final evaluation, subjective knee rating was 87%, kneeling test was positive in 7%, and Werner score was 44 of 50 (range, 30-48). Lachman test was negative in 90% at final evaluation. Sensory changes were present in 30% at 3 months, and 10% had definite hyposthesia. Computed laxity analysis revealed 90% with less than 3 mm side-to-side difference. Isokinetic testing showed normal hamstring and quadriceps peak torques at 12 months. The one-leg hop test and vertical jump were normal by 6 months. At final evaluation, average Noyes score was 88 (range, 65-100); Lysholm score, 91 (range, 70-100); postoperative Tegner rating, 6.5 (range, 5-9); and preinjury Tegner rating, 7.5 (range, 7-10). IKDC score showed 72 knees normal or nearly normal, 7 abnormal, and 1 severely abnormal. Sixty-five percent of patients returned to the same preinjury sports level.
The quadrupled bone-semitendinosus graft is a viable graft for ACL reconstruction and should be considered, especially for patients with extensor mechanism problems.
我们研究的假设是，四倍骨-半腱肌（STB）移植物能够提供临床上稳定的结构，使肢体力量恢复正常，让患者对早期恢复积极运动高度满意，且供区并发症发生率低。
结果研究。
1996年1月至1999年12月，对80例单纯前交叉韧带（ACL）损伤的运动员进行了STB移植物ACL重建术。股骨端用EndoButton（史赛克公司，马萨诸塞州安多弗）固定，胫骨端用Fastlok（Neoligaments公司，英国利兹）固定。平均随访时间为36个月（范围24 - 52个月），使用标准膝关节评分（诺伊斯、利绍姆、特格纳和国际膝关节文献委员会[IKDC]评分）、功能力量测试对患者进行评估；术后疼痛评分；术后及最终随访时的膝关节X线片；3至6个月时的磁共振成像（MRI）；3、6和12个月时的等速屈伸及内外旋转测试；最终评估时的计算机松弛度分析。
在最终评估时，膝关节主观评分为87%，跪姿试验阳性率为7%，韦纳评分为50分中的44分（范围30 - 48分）。最终评估时拉赫曼试验阴性率为90%。3个月时30%的患者有感觉改变，10%有明确的感觉减退。计算机松弛度分析显示90%的患者两侧差异小于3毫米。等速测试显示12个月时腘绳肌和股四头肌峰值扭矩正常。单腿跳试验和垂直跳在6个月时恢复正常。在最终评估时，平均诺伊斯评分为88分（范围65 - 100分）；利绍姆评分为91分（范围70 - 100分）；术后特格纳评分为6.5分（范围5 - 9分）；伤前特格纳评分为7.5分（范围7 - 10分）。IKDC评分显示72例膝关节正常或接近正常，7例异常，1例严重异常。65%的患者恢复到伤前相同的运动水平。
四倍骨-半腱肌移植物是ACL重建的一种可行移植物，尤其对于有伸膝装置问题的患者应予以考虑。
