Reid J S, Hanks G A, Kalenak A, Kottmeier S, Aronoff V
Division of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033.
J Bone Joint Surg Am. 1992 Oct;74(9):1392-402.
We studied the long-term results of the Ellison technique of extra-articular transfer of the iliotibial band, without advancement of the biceps tendon, as the sole operative treatment for a torn anterior cruciate ligament. Thirty-two patients (thirty-two knees) were evaluated an average of eleven years (range, seven to fifteen years) after the operation. The average age at the time of the operation was twenty-two years (range, sixteen to thirty-four years). Eighteen patients (56 per cent) had a modified Lysholm score of less than 84 points, indicating symptoms during the activities of daily living. Only six patients (19 per cent) had a subjectively normal knee (a modified Lysholm score of more than 94 points). The most common reason for a poor subjective score was the presence of symptoms of instability, in twenty-four patients (75 per cent). Twenty-four patients (75 per cent) had a positive pivot-shift test and twenty-nine patients (91 per cent), a positive Lachman test. Twelve patients (38 per cent) had severe (grade 3 or 4) radiographic changes. The radiographs of the knee appeared normal (grade 0) in only eight patients (25 per cent). There was a significant association between a meniscal injury and radiographic changes (p < 0.05). Fourteen patients (44 per cent) had subsequent procedures due to persistent instability or pathological changes in the articular cartilage or in a meniscus. There was a significant decline in the subjective and objective knee scores in the twenty-one patients who were evaluated at both two and eleven years. The number of patients who had a positive pivot-shift test increased from five (24 per cent) to sixteen (76 per cent). Subjectively, the number of patients who had a good result decreased from fourteen (67 per cent) to five (24 per cent). Objectively, nine patients (43 per cent) had a rating of good at two years; this fell to three (14 per cent) at eleven years. Symptomatic instability, pain, and a positive pivot-shift test were the most common reasons for a poor result. Because of the decline in the subjective and objective scores, we no longer recommend the Ellison procedure as the sole operative treatment for a torn anterior cruciate ligament of the knee.
我们研究了不推进肱二头肌腱的Ellison技术进行髂胫束关节外转移作为膝关节前交叉韧带撕裂唯一手术治疗方法的长期效果。32例患者（32个膝关节）在术后平均11年（范围7至15年）接受了评估。手术时的平均年龄为22岁（范围16至34岁）。18例患者（56%）改良Lysholm评分低于84分，表明日常生活活动时有症状。只有6例患者（19%）膝关节主观感觉正常（改良Lysholm评分高于94分）。主观评分差的最常见原因是24例患者（75%）存在不稳定症状。24例患者（75%）轴移试验阳性，29例患者（91%）Lachman试验阳性。12例患者（38%）有严重（3级或4级）影像学改变。仅8例患者（25%）膝关节X线片表现正常（0级）。半月板损伤与影像学改变之间存在显著相关性（p<0.05）。14例患者（44%）因持续不稳定或关节软骨或半月板的病理改变而接受了后续手术。在21例于2年和11年时均接受评估的患者中，膝关节主观和客观评分均显著下降。轴移试验阳性的患者数量从5例（24%）增加至16例（76%）。主观上，效果良好的患者数量从14例（67%）减少至5例（24%）。客观上，9例患者（43%）在2年时评定为良好；在11年时降至3例（14%）。有症状的不稳定、疼痛和轴移试验阳性是效果不佳的最常见原因。由于主观和客观评分下降，我们不再推荐将Ellison手术作为膝关节前交叉韧带撕裂的唯一手术治疗方法。
