Ahn Jin Hwan, Yoo Jae Chul, Yang Hyoung Seop, Kim Jae Hoon, Wang Joon Ho
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2007 Mar;15(3):242-8. doi: 10.1007/s00167-006-0177-8. Epub 2006 Oct 7.
The aim of this study is to report the arthroscopic subjective findings of reconstructed anterior cruciate ligament (ACL) with good clinical outcome. Graft used for reconstruction was either patella bone-tendon-bone (PBTB) autograft or hamstring tendon [quadrupled semitendinous and gracilis tendon (QSGT)] autograft. From March 1997 to September 2003, among 716 ACL reconstructions 209 knees (208 patients) were available for second-look arthroscopy at a mean 21.2-month (range, 14-70 months) postoperative period. The second-look arthroscopy focused on the evaluation of (1) continuity of the reconstructed ACL graft, (2) subjective graft tension using a probe, (3) the extent of synovial coverage, (4) the prevalence of cyclops or cyclops-like lesion, and (5) bony change after notchplasty. Patellar tendon autograft was used in 80 knees, hamstring tendon autograft in 129 knees. Just prior to second-look arthroscopy two objective clinical evaluations, KT-2000 arthrometer and Lysholm knee score, were performed to verify good clinical outcomes. A comparison between the hamstring tendon group and the patella tendon group, hamstring group showed slightly better results in Lysholm knee scores and KT-2000 arthrometer but there were no statistically significant differences (p>0.05). Undetected partial graft tear was seen in 21 knees (10%). With regard to graft tension, a total of 181 grafts (87%) showed normal tension and 28 (13%) showed slight lax tension. The overall synovial coverage was poor in nine (4%) knees. The synovial coverage was slightly better in the hamstring tendon group. A total of 45 knees (21.5%) showed cyclops-like lesion in variable sizes and locations. Reformation of the notch was seen in 85 knees (40%). In conclusion, the findings of second-look arthroscopy of reconstructed ACL in good clinical outcome patients showed approximately 10% partial graft tear, 5% poor synovial coverage, 20% cyclops-like lesion, and 40% some notch reformation.
本研究的目的是报告临床疗效良好的前交叉韧带（ACL）重建术后关节镜检查的主观结果。用于重建的移植物为髌腱骨-腱-骨（PBTB）自体移植物或腘绳肌腱[双股半腱肌和股薄肌腱（QSGT）]自体移植物。1997年3月至2003年9月，在716例ACL重建手术中，209例膝关节（208例患者）在术后平均21.2个月（范围14 - 70个月）时接受了二次关节镜检查。二次关节镜检查重点评估：（1）重建的ACL移植物的连续性；（2）用探针评估移植物的主观张力；（3）滑膜覆盖范围；（4）独眼巨人或类独眼巨人病变的发生率；（5）髁间窝成形术后的骨质变化。80例膝关节使用髌腱自体移植物，129例膝关节使用腘绳肌腱自体移植物。在二次关节镜检查前，进行了两项客观临床评估，即KT - 2000关节测量仪和Lysholm膝关节评分，以验证良好的临床疗效。在腘绳肌腱组和髌腱组之间进行比较，腘绳肌腱组在Lysholm膝关节评分和KT - 2000关节测量仪方面结果略好，但无统计学显著差异（p>0.05）。21例膝关节（10%）发现未检测到的部分移植物撕裂。关于移植物张力，共有181例移植物（87%）张力正常，28例（13%）张力轻度松弛。9例膝关节（4%）的滑膜覆盖总体较差。腘绳肌腱组的滑膜覆盖略好。共有45例膝关节（21.5%）出现大小和位置各异的类独眼巨人病变。85例膝关节（40%）可见髁间窝重塑。总之，临床疗效良好的ACL重建术后二次关节镜检查结果显示，约10%的部分移植物撕裂、5%的滑膜覆盖差、20%的类独眼巨人病变和40%的髁间窝重塑。
