Noyes F R, Barber S D
Cincinnati Sportsmedicine and Orthopaedic Center, Deaconess Hospital, Ohio 45219.
J Bone Joint Surg Am. 1991 Jul;73(6):882-92.
A study was performed on the effect of the addition of an extra-articular procedure involving tenodesis of the iliotibial band to a reconstruction with a bone-patellar ligament-bone allograft for the treatment of chronic rupture of the anterior cruciate ligament. One hundred and four patients were divided into two groups for comparison: Group 1 (sixty-four patients) was treated with only an intra-articular replacement with an allograft and Group 2 (forty patients), with both an intra-articular replacement with an allograft and the extra-articular procedure. Preoperatively, there were no statistically significant differences between the two groups in terms of twenty variables, including body weight, level of activity, anterior-posterior displacements, number of previous operations, and duration of follow-up. All of the patients returned for follow-up evaluation twenty-three to fifty-four months (mean, thirty-five months) postoperatively. All were treated with the same postoperative program of immediate motion of the knee and rehabilitation. The results were evaluated with the use of a comprehensive subjective and objective system that rated the twenty factors. Both procedures proved to be effective in decreasing functional limitations and symptoms and in improving the level of sports activity and the over-all scores. The results in Group 2 were significantly better than those in Group 1, as measured with tests done with the KT-1000 arthrometer (p less than 0.01) and with regard to the level of sports activity (p less than 0.05) and the over-all scores (p less than 0.01). There was no postoperative difference between the two groups in terms of the results on pivot-shift or isokinetic testing, patellofemoral crepitus, functional limitations, or symptoms. The program of rehabilitation effectively restored 0 to 135 degrees of motion to all but four knees, which lacked 5 degrees of extension at the most recent follow-up. The over-all rate of failure for both groups was 11 per cent. However, the rate of failure was 16 per cent (ten of sixty-four knees) in Group 1 and only 3 per cent (one of forty knees) in Group 2. This difference was significant (p less than 0.05). The extra-articular procedure appeared to provide support to the healing intra-articular allograft by reducing deleterious forces and tibial displacements, and to restore the secondary restraints provided by the lateral iliotibial band. The results suggest that the combination of the procedures is of value in young, athletically active people who have chronic rupture of the anterior cruciate ligament.(ABSTRACT TRUNCATED AT 400 WORDS)
一项研究探讨了在使用骨-髌腱-骨同种异体移植重建治疗前交叉韧带慢性断裂时，增加一项包括髂胫束固定术的关节外手术的效果。104例患者被分为两组进行比较：第1组（64例患者）仅接受同种异体移植的关节内置换治疗，第2组（40例患者）接受同种异体移植的关节内置换及关节外手术。术前，两组在20项变量方面无统计学显著差异，包括体重、活动水平、前后移位、既往手术次数及随访时间。所有患者在术后23至54个月（平均35个月）返回进行随访评估。所有患者均接受相同的术后膝关节立即活动及康复计划。结果采用综合主观和客观系统进行评估，该系统对20项因素进行评分。两种手术在减少功能受限和症状、提高体育活动水平及总体评分方面均被证明有效。用KT-1000关节测量仪进行测试（p<0.01）以及就体育活动水平（p<0.05）和总体评分（p<0.01）而言，第2组的结果显著优于第1组。两组在轴移或等速测试结果、髌股摩擦音、功能受限或症状方面术后无差异。康复计划有效地使除4个膝关节外的所有膝关节恢复了0至135度的活动度，这4个膝关节在最近一次随访时最多缺少5度的伸展。两组的总体失败率均为11%。然而，第1组的失败率为16%（64个膝关节中的10个），第2组仅为3%（40个膝关节中的1个）。这种差异具有显著性（p<0.05）。关节外手术似乎通过减少有害力量和胫骨移位为愈合中的关节内同种异体移植提供支持，并恢复外侧髂胫束提供的二级约束。结果表明，对于患有前交叉韧带慢性断裂的年轻、有运动活力的人群，联合手术具有价值。（摘要截短至400字）
