Lorenz Stephan, Anetzberger Hermann, Spang Jeffrey T, Imhoff Andreas B
Abteilung Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, München, Germany.
Oper Orthop Traumatol. 2007 Dec;19(5-6):473-88. doi: 10.1007/s00064-007-1027-3.
To improve the rotational stability of the knee by anatomic reconstruction of the anterior cruciate ligament by socalled double-bundle technique using anteromedial and posterolateral grafts from native semitendinosus and gracilis. The grafts are fixed with bioabsorbable screws utilizing aperture fixation.
Complete tear of the anterior cruciate ligament with positive Lachman sign and pivot shift.
Open growth plate. Osteoarthritis > grade 1 according to Jäger & Wirth. Age > or = 50 years with low sports activity (relative contraindication).
Graft harvest of the semitendinosus and gracilis tendons via a 3-cm horizontal skin incision parallel to pes anserinus and preparation of the tendons as double-looped grafts. Arthroscopy, resection of the stump of the anterior cruciate ligament, and clearance of its origin and insertion. Tunnel placement by means of aiming devices in the following order: tibial posterolateral, tibial anteromedial, femoral anteromedial (transtibial or via the anteromedial portal in 120 degrees flexion), and femoral posterolateral (via additional medial arthroscopic portal). The anteromedial (semitendinosus tendon) and posterolateral (gracilis tendon) bundles are passed through the tunnels and fixed on the femoral side. Tibial fixation of the graft by bioresorbable interference screw with knee flexion of 45 degrees (anteromedial) and 10 degrees (posterolateral).
Depending on the degree of swelling, rehabilitation with partial weight bearing for 14 days and full range of motion. Return to sports after 6 months, no contact sports until 9 months.
From May 2004 to June 2005, anatomic double-bundle reconstruction was performed in 19 patients (13 male, six female, average age 31 years [18-48 years]) with isolated anterior cruciate ligament rupture without concomitant lesions. Clinical follow-up examination on average at 21.3 months (16-30 months) postoperatively. The Lysholm Score improved from an average of 65.2 to 94.5 points (75-100 points). The IKDC (International Knee Documentation Committee) Score yielded nine very good and ten good results in the relevant subgroups of motion, effusion and ligament stability. Measurement of anteroposterior translation with the KT-1000 instrument at 134 N showed increased translation of 1.8 mm (-2 to 5 mm) compared to the contralateral knee.
通过采用所谓的双束技术，利用取自自体半腱肌和股薄肌的前内侧和后外侧移植物对前交叉韧带进行解剖重建，以提高膝关节的旋转稳定性。移植物通过可吸收螺钉采用孔径固定法进行固定。
前交叉韧带完全撕裂且Lachman试验阳性和轴移试验阳性。
开放生长板。根据耶格和维尔特标准，骨关节炎>1级。年龄≥50岁且体育活动量低（相对禁忌症）。
通过在鹅足腱平行处做一个3厘米的水平皮肤切口获取半腱肌和股薄肌腱，并将肌腱制备成双环移植物。关节镜检查，切除前交叉韧带残端，并清理其起点和止点。使用瞄准装置按以下顺序放置隧道：胫骨后外侧、胫骨前内侧、股骨前内侧（经胫骨或在膝关节屈曲120度时通过前内侧入路）和股骨后外侧（通过额外的内侧关节镜入路）。将前内侧（半腱肌腱）和后外侧（股薄肌腱）束穿过隧道并固定在股骨侧。在膝关节屈曲45度（前内侧）和10度（后外侧）时，用可吸收加压螺钉对移植物进行胫骨固定。
根据肿胀程度，进行14天的部分负重康复训练并进行全范围活动。6个月后恢复运动，9个月内禁止进行接触性运动。
2004年5月至2005年6月，对19例（13例男性，6例女性，平均年龄31岁[18 - 48岁]）孤立性前交叉韧带断裂且无合并损伤的患者进行了解剖双束重建。术后平均21.3个月（16 - 30个月）进行临床随访检查。Lysholm评分从平均65.2分提高到94.5分（75 - 100分）。国际膝关节文献委员会（IKDC）评分在运动、积液和韧带稳定性相关亚组中产生了9个优和10个良的结果。使用KT - 1000仪器在134 N力下测量前后向平移，与对侧膝关节相比，平移增加了1.8毫米（-2至5毫米）。
