Ishibashi Yasuyuki, Tsuda Eiichi, Yamamoto Yuji, Tsukada Harehiko, Toh Satoshi
Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Arthroscopy. 2009 May;25(5):488-95. doi: 10.1016/j.arthro.2008.10.008. Epub 2008 Dec 18.
The purpose of this study was to assess the pivot-shift phenomenon during double-bundle anterior cruciate ligament (ACL) reconstruction using a navigation system.
Ninety patients who received navigated double-bundle ACL reconstruction were included in this study. The mean age of the patients was 21.9 years. During reconstruction, pivot-shift tests were performed 4 times: before reconstruction, after the posterolateral bundle fixation, after the anteromedial bundle fixation, and after the double-bundle reconstruction. Both tibial internal rotation and anterior translation under the pivot-shift test were measured at each phase by the additional functions of the navigation. The navigation system used in this study was the image-free, which does not require preoperative or intraoperative images, OrthoPilot ACL (version 2.0; B. Braun Aesculap, Tuttlingen, Germany).
Before ACL reconstruction, average (+/- standard deviation) tibial internal rotation and anterior translation under the pivot-shift test were 23.7 degrees +/- 6.1 degrees and 5.2 +/- 2.4 mm. They were significantly decreased to 20.9 degrees +/- 6.4 degrees and 2.3 +/- 1.1 mm after the posterolateral bundle fixation, and also decreased to 22.2 degrees +/- 5.7 degrees and 2.4 +/- 1.1 mm after the anteromedial bundle fixation. There was no significant difference between the groups. After double-bundle reconstruction, they improved to 20.3 degrees +/- 6.3 degrees and 2.0 +/- 1.0 mm.
Our results indicate that both the posterolateral and the anteromedial bundle similarly control both anterior translation and internal rotation during pivot-shift testing. Double-bundle reconstruction may further improve knee stability.
Level II, development of diagnostic criteria on basis of consecutive patients with universally applied reference gold standard.
本研究旨在评估使用导航系统进行双束前交叉韧带（ACL）重建时的轴移现象。
本研究纳入了90例行导航双束ACL重建的患者。患者的平均年龄为21.9岁。在重建过程中，进行了4次轴移试验：重建前、后外侧束固定后、前内侧束固定后以及双束重建后。在每个阶段，通过导航的附加功能测量轴移试验下的胫骨内旋和前移情况。本研究中使用的导航系统是无图像的，即不需要术前或术中图像的OrthoPilot ACL（版本2.0；德国图特林根市贝朗蛇牌）。
在ACL重建前，轴移试验下胫骨内旋和前移的平均值（±标准差）分别为23.7°±6.1°和5.2±2.4mm。在后外侧束固定后，显著降低至20.9°±6.4°和2.3±1.1mm，在前内侧束固定后也降低至22.2°±5.7°和2.4±1.1mm。两组之间无显著差异。双束重建后，分别改善至20.3°±6.3°和2.0±1.0mm。
我们的结果表明，在轴移试验中，后外侧束和前内侧束在控制前移和内旋方面作用相似。双束重建可能进一步改善膝关节稳定性。
II级，基于连续患者并采用普遍适用的参考金标准制定诊断标准。
