Thomas Neil P, Kankate Raghu, Wandless Felicity, Pandit Hemant
North Hampshire Hospital, Basingstoke, UK.
Am J Sports Med. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. Epub 2005 Aug 10.
Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored.
A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction.
Case control study; Level of evidence, 3.
This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P).
In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25).
This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower.
前交叉韧带翻修手术通常被视为一种目标有限的挽救性手术。然而，这种局限性并非必然如此。与初次重建相似，目标应该是选择合适的移植物并将其置于质量良好的骨的解剖位置。高质量骨的问题似乎一直被忽视。
采用胫骨隧道植骨和不同股骨隧道的两阶段前交叉韧带翻修重建将产生与初次前交叉韧带重建相似的测量膝关节松弛度和国际膝关节文献委员会评分。
病例对照研究；证据等级，3级。
这项前瞻性研究纳入了1993年至2000年由一名外科医生连续进行的49例两阶段前交叉韧带翻修手术（R组）。如果先前重建手术的胫骨隧道会与正确放置的翻修隧道重叠（部分或完全），则进行两阶段翻修手术。第一阶段包括移除旧移植物和干扰性金属制品，同时对胫骨隧道进行植骨。在使用计算机断层扫描确保植骨充分融合后，进行第二阶段翻修。此阶段包括采集自体移植物、将其进行解剖学放置并进行充分固定。将结果与一组匹配的初次前交叉韧带重建患者（P组）的结果进行比较。
在R组中，由于半月板和软骨损伤更为常见，国际膝关节文献委员会评分低于P组（R组为61.2分，P组为72.8分；P = 0.006）。两组的客观松弛度测量结果相似（R组为1.36 mm，P组为1.2 mm；P = 0.25）。
本研究表明，两阶段翻修前交叉韧带重建所获得的松弛度测量结果可与初次前交叉韧带重建后的结果相似，尽管国际膝关节文献委员会评分较低。
