Saowaprut Suriyapong, Tanpowpong Thanathep, Piyaskulkaew Chaiwat
Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2009 Apr;92(4):510-6.
To compare the sagittal obliquity of anterior cruciate ligament graft with normal native anterior cruciate ligament in contralateral knee, to determine the effect of sagittal obliquity and axial femoral tunnel graft placement on stability and functional knee score (Lysholm), and to measure size of graft after complete ligamentization.
Seventy single tunnel quadruple hamstring anterior cruciate reconstructed knee in unilateral ACL injury patients were evaluated at 18 months after surgery. At follow up, patients were evaluated including measurement of knee laxity by using side to side different on KT 1000 arthromeres and clinical outcome by completed Lysholm functional knee questionnaires. Sagittal T1 weighted magnetic resonance image with complete dimension of graft from origin to insertion on each side of knee were depicted to compare the obliquity by measuring the intersection angle of the graft line with the tibial plateau plane. The axial femoral tunnel was determined by angle between anteroposterior axis of distal femur and long axis of femoral tunnel. The diameter of graft was also measured.
Graft obliquity was average 58 degrees with range between 41 degrees and 69 degrees. In contralateral native ACL obliquity was average 50 degrees with range between 33 degrees and 63 degrees. The difference between the two groups was statistically significant (p < 0.0001). Average axial femoral tunnel was 36 degrees with range between 10 degrees and 56 degrees. Knee laxity (KT-1 000 arthrometer; average pre-op = 6, post-op = 3) and Lysholm knee scores (average score; pre-op 55, post-op score 89) were significantly improved after surgery (p < 0.01). There was no correlation between degree of sagittal obliquity and axial femoral tunnel with knee laxity and functional score in this series. Graft size was increased in average 8% after 18 months post-operatively.
ACL grafts in patients with appropriate tibial tunnel placement were more vertical than native ACL. There was no significant effect of degree of sagittal obliquity and axial femoral tunnel to antero-postero stability and knee score. ACL graft size was increased in diameter during post-operative period. Graft-notch distance should be considered during operation.
比较前交叉韧带移植物与对侧膝关节正常原生前交叉韧带的矢状倾斜度，确定矢状倾斜度和股骨隧道轴向移植物放置对膝关节稳定性和功能评分（Lysholm）的影响，并测量韧带完全化后移植物的尺寸。
对70例单侧前交叉韧带损伤患者行单隧道四股绳肌前交叉韧带重建术后18个月进行评估。随访时，对患者进行评估，包括使用KT 1000关节测量仪测量膝关节松弛度，以及通过完成Lysholm膝关节功能问卷评估临床结果。描绘膝关节两侧从起点到止点的移植物完整尺寸的矢状面T1加权磁共振图像，通过测量移植物线与胫骨平台平面的相交角度来比较倾斜度。股骨隧道轴向由股骨远端前后轴与股骨隧道长轴之间的角度确定。同时测量移植物的直径。
移植物倾斜度平均为58度，范围在41度至69度之间。对侧原生前交叉韧带倾斜度平均为50度，范围在33度至63度之间。两组之间的差异具有统计学意义（p < 0.0001）。股骨隧道轴向平均为36度，范围在10度至56度之间。术后膝关节松弛度（KT-1000关节测量仪；术前平均 = 6，术后 = 3）和Lysholm膝关节评分（平均评分；术前55分，术后评分89分）显著改善（p < 0.01）。在本系列中，矢状倾斜度和股骨隧道轴向与膝关节松弛度和功能评分之间无相关性。术后18个月移植物尺寸平均增加8%。
胫骨隧道放置合适的患者，前交叉韧带移植物比原生前交叉韧带更垂直。矢状倾斜度和股骨隧道轴向对前后稳定性和膝关节评分无显著影响。术后期间前交叉韧带移植物直径增加。手术时应考虑移植物-切迹距离。
