Jones Alex P, Sidhom Sameh, Sefton Graham
Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Cleveland, United Kingdom.
J Long Term Eff Med Implants. 2007;17(1):59-69. doi: 10.1615/jlongtermeffmedimplants.v17.i1.90.
Prosthetic ligament use for anterior cruciate ligament (ACL) reconstruction was popular in the 1980s and 1990s. Information from published studies regarding the long-term outcomes of this surgery is limited. This paper presents the long-term results of stabilization of the ACL deficient knee using the Leeds-Keio synthetic ligament formed from woven polyester. Fifty patients were seen in clinic at a mean follow-up of 11.9 years (range 8.7-19.7 years). The mean ages were: at injury 26.8 years (range 16-47 years), at surgery 29.9 years (range 18-47 years), and at review 42 years (30-56 years). Of the 50 patients included, 86% were male and 14% were female. The main causes of injury were football (42%), rugby (25%), and skiing (8%). The mean time from injury to surgery was 37.6 months (range 0-324 months). All patients received intra-articular (IA) ligaments placed in the anatomical position of the natural ACL. In addition, approximately 75% also had an extra-articular ligament placed so that it ran parallel to the IA component on the lateral aspect of the knee. At review, patients were thoroughly assessed with history, examination, and IKDC criteria. IKDC scores were excellent or good in 92% of patients seen while combined IKDC and thorough clinical history findings were good or excellent in 84% of patients seen. Patient satisfaction was high with 90% of patients being satisfied or very satisfied with the outcome of surgery. Activity levels were also high according to IKDC criteria. At one year postoperatively, approximately 66% of patients had returned to their preinjury level of activity. At review, almost half of all patients still maintained this level. Of those patients who did not, only 6% attributed this to knee instability. Furthermore, the vast majority of patients (92%) still had activity levels superior to that of postinjury/preoperatively. Rupture of the intra-articular component was confirmed in six cases (12%) and three of these patients continued to experience functional knee instability. These results demonstrate that synthetic ligament can provide long-term functional stability in the knee following a loss of the ACL.
人工韧带用于前交叉韧带（ACL）重建在20世纪80年代和90年代很流行。已发表研究中关于该手术长期结果的信息有限。本文介绍了使用由编织聚酯制成的利兹 - 庆应义塾合成韧带稳定ACL损伤膝关节的长期结果。50例患者在门诊接受随访，平均随访时间为11.9年（范围8.7 - 19.7年）。平均年龄分别为：受伤时26.8岁（范围16 - 47岁），手术时29.9岁（范围18 - 47岁），复查时42岁（30 - 56岁）。纳入的50例患者中，86%为男性，14%为女性。受伤的主要原因是足球（42%）、橄榄球（25%）和滑雪（8%）。受伤至手术的平均时间为37.6个月（范围0 - 324个月）。所有患者均在天然ACL的解剖位置置入关节内（IA）韧带。此外，约75%的患者还置入了关节外韧带，使其在膝关节外侧与IA组件平行。复查时，通过病史、检查和IKDC标准对患者进行全面评估。在接受检查的患者中，92%的患者IKDC评分优秀或良好，而结合IKDC和全面临床病史结果来看，84%的患者良好或优秀。患者满意度较高，90%的患者对手术结果满意或非常满意。根据IKDC标准，活动水平也较高。术后一年，约66%的患者恢复到受伤前的活动水平。复查时，几乎一半的患者仍保持这一水平。在未恢复到该水平的患者中，只有6%将其归因于膝关节不稳定。此外，绝大多数患者（92%）的活动水平仍优于受伤后/术前。6例（12%）患者证实关节内组件破裂，其中3例患者仍存在膝关节功能不稳定。这些结果表明，合成韧带可在ACL缺失后为膝关节提供长期功能稳定性。
