Steadman J Richard, Cameron-Donaldson Michelle L, Briggs Karen K, Rodkey William G
Steadman Hawkins Research Foundation, Dept of Clinical Research, Vail, CO 81657, USA.
J Knee Surg. 2006 Jan;19(1):8-13. doi: 10.1055/s-0030-1248070.
This study documents outcomes of athletically active, skeletally immature patients with proximal anterior cruciate ligament (ACL) tears treated with a non-reconstructive technique to promote healing ("healing response"). Between 1992 and 1998, 13 skeletally immature athletes with proximal ACL tears underwent a healing response procedure. Patients with previous ACL injury, other concurrent ligament pathology, and/or complete mid-substance ACL tears were excluded. Average preoperative KT-1000 arthrometer manual maximum difference for all patients was 5 mm (range: 3-10 mm). Preoperatively, all patients had a 1+ or 2+ pivot shift, and all patients reported knee function as abnormal or severely abnormal. Patients were followed prospectively with clinical examinations, KT-1000 testing, and subjective questionnaires. Three (23%) patients had a re-injury 30 to 55 months after the healing response and underwent subsequent ACL reconstruction. Subjective follow-up on the remaining 10 patients at an average of 69 months (range: 26-113 months) postoperatively indicated no patients experienced pain or giving way, and all considered their knee function normal. Average Lysholm score was 96, Tegner score was 8.5 (range: 7-10), and patient satisfaction at follow-up was 9.9 (1=very dissatisfied and 10=very satisfied). Clinical examination at least one year postoperatively was performed on 7 of 10 patients at 35 months (range: 12-63 months). Five patients had a negative pivot shift and 2 had a 1+ pivot shift. KT-1000 measurements improved to 2 mm (range: 0-3 mm). In the athletically active, skeletally immature patient, the healing response procedure can restore stability and knee function, with proper patient selection. In this study group, patients were very satisfied with the procedure and returned to a high level of sports and activities.
本研究记录了采用非重建技术促进愈合（“愈合反应”）治疗的骨骼未成熟、运动活跃的前交叉韧带（ACL）近端撕裂患者的治疗结果。1992年至1998年期间，13名骨骼未成熟的ACL近端撕裂运动员接受了愈合反应手术。排除既往有ACL损伤、其他并发韧带病变和/或ACL实质中部完全撕裂的患者。所有患者术前KT-1000关节测量仪手动最大差值平均为5mm（范围：3-10mm）。术前，所有患者均有1+或2+的轴移，且所有患者均报告膝关节功能异常或严重异常。对患者进行前瞻性随访，包括临床检查、KT-1000测试和主观问卷调查。3例（23%）患者在愈合反应后30至55个月再次受伤，随后接受了ACL重建。其余10例患者术后平均69个月（范围：26-113个月）的主观随访表明，没有患者出现疼痛或打软腿，所有患者均认为其膝关节功能正常。Lysholm评分平均为96分，Tegner评分为8.5分（范围：7-10分），随访时患者满意度为9.9分（1分为非常不满意，10分为非常满意）。10例患者中的7例在术后35个月（范围：12-63个月）进行了至少一年的临床检查。5例患者轴移阴性，2例患者有1+轴移。KT-1000测量值改善至2mm（范围：0-3mm）。对于骨骼未成熟、运动活跃的患者，在进行适当的患者选择后，愈合反应手术可以恢复膝关节稳定性和功能。在本研究组中，患者对该手术非常满意，并恢复到高水平的运动和活动。
