Laxdal Gauti, Kartus Jüri, Eriksson Bengt I, Faxén Eva, Sernert Ninni, Karlsson Jon
Department of Orthopaedics, Sahlgrenska University Hospital/Ostra, SE-416 85 Göteborg, Sweden.
Am J Sports Med. 2006 Oct;34(10):1574-80. doi: 10.1177/0363546506288014. Epub 2006 May 9.
The use of biodegradable screws in anterior cruciate ligament reconstruction has grown in popularity.
To compare the clinical and radiographic results in arthroscopically assisted anterior cruciate ligament reconstruction using 4-strand hamstring tendon grafts and either metallic (metal group) or biodegradable (PLLA group) interference screw fixation.
Randomized controlled trial; Level of evidence, 1.
A randomized series of 77 patients, all with a unilateral anterior cruciate ligament rupture, was included in the study. The preoperative assessments in both groups were similar in gender, Tegner activity level, Lysholm score, KT-1000 arthrometer measurements, and single-legged hop test results. In both groups, interference screw fixation of the graft was used at both ends, and 68 of 77 (88%) patients returned for a radiographic examination at 6 and 24 months, respectively.
At follow-up, no significant differences were found between the 2 groups in KT-1000 arthrometer laxity measurements, Tegner activity level, or Lysholm score. The PLLA group had a significantly better outcome in the single-legged hop test and the final International Knee Documentation Committee classification (P = .007 and P = .03, respectively). At 6 and 24 months after the index operation, the PLLA group displayed significantly larger drill holes on the radiographs than did the metal group on both the tibial (8.1 vs 6.6 mm at 6 months [P = .0007]; 6.0 vs 3.2 mm at 24 months [P < .0001]) and femoral sides (7.8 vs 5.6 mm at 6 months [P < .0001]; 6.3 vs 1.9 mm at 24 months [P < .0001]).
There were significantly larger radiographically visible drill holes on both the tibial and femoral sides in the PLLA group compared with the metal group at 6 and 24 months. Clinical examination at 2 years revealed no major differences between the groups. The larger drill holes in the PLLA group did not correlate with inferior clinical results.
可生物降解螺钉在前交叉韧带重建中的应用日益普及。
比较在关节镜辅助下使用4股绳肌腱移植物并采用金属（金属组）或可生物降解（聚乳酸组，PLLA组）挤压螺钉固定进行前交叉韧带重建的临床和影像学结果。
随机对照试验；证据等级为1级。
本研究纳入了77例单侧前交叉韧带断裂的患者。两组患者术前在性别、Tegner活动水平、Lysholm评分、KT-1000关节测量仪测量结果以及单腿跳测试结果方面相似。两组均在移植物两端使用挤压螺钉固定，77例患者中有68例（88%）分别在6个月和24个月时返回进行影像学检查。
随访时，两组在KT-1000关节测量仪松弛度测量、Tegner活动水平或Lysholm评分方面未发现显著差异。PLLA组在单腿跳测试和最终国际膝关节文献委员会分类方面的结果明显更好（分别为P = 0.007和P = 0.03）。在初次手术6个月和24个月时，PLLA组在X线片上显示的胫骨侧钻孔明显大于金属组（6个月时分别为8.1 vs 6.6 mm [P = 0.0007]；24个月时为6.0 vs 3.2 mm [P < 0.0001]），股骨侧也是如此（6个月时为7.8 vs 5.6 mm [P < 0.0001]；24个月时为6.3 vs 1.9 mm [P < 0.0001]）。
与金属组相比，PLLA组在6个月和24个月时胫骨侧和股骨侧在X线片上可见的钻孔明显更大。2年时的临床检查显示两组之间无重大差异。PLLA组较大的钻孔与较差的临床结果无关。
