Guo Lin, Chen Hao, He Rui, Yang Liu, Duan Xiaojun, Huang Hongbo, Zheng Lu, Dai Wei
Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):921-4.
To investigate the surgical technique and short-term effectiveness of anterior cruciate ligament (ACL) reconstruction with LARS artificial ligament.
Between November 2008 and April 2010, eighty patients with ACL injury were treated with LARS artificial ligament under arthroscope and successfully followed up. There were 51 males and 29 females, aged from 17 to 43 years with an average of 29.2 years. The injuries were caused by sport in 63 cases, traffic accident in 14 cases, and bruise in 3 cases. There were 43 left knees and 37 right knees. The disease duration ranged from 10 days to 11 months. The anterior drawer test, Lachman test, and pivot shift test for all cases were rated as positive. The preoperative Lysholm score was 55.4 +/- 5.7, Irgang score was 48.3 +/- 6.2, and Larson score was 54.8 +/- 7.4; and the International Knee Documentation Committee (IKDC) score was lower than normal level in all cases. Oblique coronal MRI showed ACL injury in all cases. Residual ACL and synovium were preserved during surgery.
All incisions healed by first intention without complication of infection or deep venous thrombosis. All patients were followed up 7 to 24 months with an average of 16.8 months. There were 3 cases of screws exposure toward femoral cortical bone, 2 cases of loosening tibial screw, and 1 case of knee extension limitation, and they were cured after symptomatic treatment. No LARS artificial ligament rupture and joint fibrosis occurred during follow-up. At last follow-up, the results of anterior drawer test, Lachman test, and pivot shift test were positive in 2, 3, and 3 patients, respectively. There were significant differences in Lysholm, Irgang, and Larson scores of affected knees between preoperation and 6 weeks postoperatively, last follow-up, respectively (P < 0.05). The normal rate of IKDC score were 43.75% (35/80) and 97.50% (78/80) at 6 weeks postoperatively and last follow-up, respectively.
The viscoelastic properties of LARS artificial ligament is different from that of biological materials. The graft should be fixed at a relatively extension position to avoid knee extension limitation and slight loosening of graft tension is permitted at flexion position. Good clinical result could be achieved if the technique is well applied.
探讨采用LARS人工韧带行前交叉韧带（ACL）重建的手术技术及短期疗效。
2008年11月至2010年4月，80例ACL损伤患者在关节镜下采用LARS人工韧带治疗并获得成功随访。其中男性51例，女性29例，年龄17～43岁，平均29.2岁。损伤原因：运动损伤63例，交通事故伤14例，摔伤3例。左膝43例，右膝37例。病程10天至11个月。所有病例前抽屉试验、Lachman试验及轴移试验均为阳性。术前Lysholm评分55.4±5.7，Irgang评分48.3±6.2，Larson评分54.8±7.4；国际膝关节文献委员会（IKDC）评分均低于正常水平。斜冠状面MRI显示所有病例均有ACL损伤。手术中保留残余ACL及滑膜。
所有切口均一期愈合，无感染及深静脉血栓形成等并发症。所有患者随访7～24个月，平均16.8个月。发生股骨皮质骨螺钉外露3例，胫骨螺钉松动2例，膝关节伸直受限1例，经对症处理后均治愈。随访期间未发生LARS人工韧带断裂及关节纤维化。末次随访时，前抽屉试验、Lachman试验及轴移试验阳性者分别为2、3、3例。患膝Lysholm、Irgang及Larson评分术前与术后6周、末次随访比较，差异均有统计学意义（P<0.05）。术后6周及末次随访时IKDC评分正常率分别为43.75%（35/80）和97.50%（78/80）。
LARS人工韧带的黏弹性与生物材料不同。移植物应固定在相对伸直位以避免膝关节伸直受限，屈曲位允许移植物张力稍有松弛。应用该技术可取得良好的临床效果。
