Laboureau J P, Cazenave A
Centre Orthopédique et traumatologique, Chenove.
Rev Chir Orthop Reparatrice Appar Mot. 1991;77(2):92-102.
225 patients with acute rupture of the anterior cruciate ligament were operated upon with a knitted polyester synthetic ligament (Ligastic) reinforced by a suture of the anterior cruciate ligament remnant. Five technical points must respected during the implantation of the ligament: isometry, direction of the femoral and tibial tunnels, absence of abrasion of the ligament in the notch, tensioning of the synthetic ligament equal to the natural cruciate ligament, careful suture of the remnants of the ruptured anterior cruciate around the synthetic ligament replacement. The functional results, according to the rating system of ARPEGE, demonstrated 8.6 on the stability scale, 8.1 for pain, 8.7 for mobility; 87 per cent of the competitors were able to return to their sport at the same level. There were no cases of acute synovitis. The patients were separated into three groups for evaluation: Group I--More than three years follow-up. Group II--More than two years follow-up. Group III--Less than two years follow-up. An anterior drawer test of less than 5 mm was observed in 85 per cent of Group I, 88 per cent of Group II, and 87 per cent of Group III. A negative jerk test was noted in 92 per cent of Group I, 95 per cent of Group II and 95 per cent of Group III. These differences were not statistically significant. On follow-up, a Lachman test of less than 5 mm was found respectively in 37 per cent, 70 per cent and 79 per cent; this difference was statistically significant. The relatively mediocre results of the Lachman test in Group I led us to follow a more precise isometric method. Postoperative cases were reexamined and demonstrated that the artificial ligament had become covered with an oriented fibrous tissue. The long-term outlook also depended on a successful restoration of proprioception in the repaired remnant of the anterior cruciate.
225例前交叉韧带急性断裂患者接受了用编织聚酯合成韧带（Ligastic）并通过前交叉韧带残余物缝线加强的手术。在韧带植入过程中必须注意五个技术要点：等长性、股骨和胫骨隧道的方向、韧带在髁间切迹处无磨损、合成韧带的张力等于天然交叉韧带、仔细缝合断裂的前交叉韧带残余物使其围绕合成韧带替代物。根据ARPEGE评分系统，功能结果显示稳定性评分为8.6，疼痛评分为8.1，活动度评分为8.7；87%的运动员能够恢复到原来的运动水平。没有急性滑膜炎病例。患者被分为三组进行评估：第一组——随访超过三年。第二组——随访超过两年。第三组——随访少于两年。第一组85%、第二组88%、第三组87%的患者前抽屉试验小于5毫米。第一组92%、第二组95%、第三组95%的患者急拉试验为阴性。这些差异无统计学意义。随访时，Lachman试验小于5毫米的患者分别为37%、70%和79%；这一差异具有统计学意义。第一组Lachman试验结果相对一般，促使我们采用更精确的等长方法。对术后病例进行复查，结果显示人工韧带已被定向纤维组织覆盖。长期预后还取决于前交叉韧带修复残余物中本体感觉的成功恢复。
