Strand T, Mølster A, Hordvik M, Krukhaug Y
Department of Orthopaedic Surgery, Diakonissehjemmets Sykehus, 5009 Bergen, Norway.
Arch Orthop Trauma Surg. 2005 May;125(4):217-21. doi: 10.1007/s00402-004-0766-2. Epub 2004 Nov 26.
We have previously reported results after 2-5 and 5-10 years follow-up of repair of acute anterior cruciate ligament (ACL) ruptures by suturing. Reports of results after more than 10 years are rare.
A total of 140 patients were operated on in the period 1975-1983 (age range 13-71 years, median 28 years) by the modified Palmer technique. Only 2 meniscus resections and 4 meniscectomies were performed at the primary operation; while 28 menisci were sutured. At follow-up,12 patients were dead. Eighteen patients (13%) underwent repeat operations for secondary instability. Of the remaining 110 patients, 81 appeared for follow-up.
Only 6 secondary meniscus resections were performed, all in the group of 18 patients operated on again for instability. No secondary meniscus surgery was performed on the 81 patients who appeared for follow-up. The median Lysholm score was 88, and 58 of the 81 patients (71%) classified their total knee function as good or excellent. By KT-1000 testing, 33 (41%) patients had less than 3 mm anterior instability, 29 (36%) had 3-5 mm instability, and 17 (21%) had more than 5 mm. With 18 patients from the total of 128 living patients re-operated for instability, we estimate the rate of total failure of stability as 27%. Radiological osteoarthritis grade C was present in 8 operated and 2 control knees, while only 1 operated knee revealed osteoarthritis grade D. Thirty-four operated and 20 control knees had grade B. Osteoarthritis was correlated to more advanced age at injury, while correlation to function could not be proven. Radiographs were obtained of 61 patients at follow-up.
Some 50% of patients had stable or slightly unstable knees, and 40% good or excellent function according to the Lysholm score. Re-operation for instability was more frequent in younger patients, while ostearthritis was more frequent in older patients. The rate of meniscus resection or extirpation was low. Open repair by suture is no longer recommended. Further research is indicated on the possible use of refixation of the ruptured ACL by arthroscopy.
我们之前曾报告过采用缝合修复急性前交叉韧带（ACL）断裂后2至5年以及5至10年的随访结果。超过10年的随访结果报告较为罕见。
1975年至1983年期间，共有140例患者接受了改良帕尔默技术手术（年龄范围13至71岁，中位数28岁）。初次手术时仅进行了2例半月板切除术和4例半月板摘除术；同时缝合了28个半月板。随访时，12例患者死亡。18例患者（13%）因继发性不稳定接受了再次手术。在其余110例患者中，81例前来接受随访。
仅对18例因不稳定再次手术的患者中的6例进行了继发性半月板切除术。对前来随访的81例患者未进行继发性半月板手术。Lysholm评分中位数为88分，81例患者中有58例（71%）将其全膝关节功能评为良好或优秀。通过KT - 1000测试，33例（41%）患者的前向不稳定小于3毫米，29例（36%）患者的不稳定为3至5毫米，17例（21%）患者的不稳定超过5毫米。在总共128例存活患者中，有18例因不稳定再次手术，我们估计稳定性完全失败的发生率为27%。8例手术膝关节和2例对照膝关节出现C级放射性骨关节炎，而仅1例手术膝关节显示为D级骨关节炎。34例手术膝关节和20例对照膝关节为B级。骨关节炎与受伤时年龄较大有关，而与功能的相关性未得到证实。随访时对61例患者进行了X线检查。
根据Lysholm评分，约50%的患者膝关节稳定或轻度不稳定，40%的患者功能良好或优秀。年轻患者因不稳定进行再次手术的频率更高，而老年患者骨关节炎更为常见。半月板切除或摘除率较低。不再推荐采用开放缝合修复。建议对关节镜下修复断裂ACL的可能性进行进一步研究。
