Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, 4101, Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2013 Apr;21(4):957-64. doi: 10.1007/s00167-012-2001-y. Epub 2012 Apr 10.
The primary purpose of our study was to analyse the long-term outcome of patients treated for anterior cruciate ligament (ACL) tears by anatomical single-bundle ACL reconstruction with patellar tendon autograft. The secondary purpose was to identify predictive factors for good outcome and occurrence of osteoarthritis.
Sixty-three patients (m:f = 54:9; mean age at surgery, 27 ± 7 years) treated by ACL reconstruction were evaluated with a mean follow-up of 16 ± 1 years using IKDC2000, the SF36, Lysholm and Tegner score, Knee Society score, visual analogue scale for pain and satisfaction and KOOS. The femoral tunnel position was evaluated according to Sommer. It was also assessed in percentage of the Blumensaat line and the tibial tunnel position in percentage of the total anterior-posterior plateau length. The extent of osteoarthritis was graded according to the Kellgren-Lawrence score.
The total IKDC2000 was normal in 20 (32 %), nearly normal in 29 (46 %), abnormal in 12 (19 %) and severely abnormal in 3 (5 %) of patients. The mean total SF-36 was 89 ± 13, the Lysholm score 95 ± 12, the Knee Society score 191 ± 16 and the total KOOS 84 ± 19. The Tegner score decreased from pre-injury 7(4-10) to 6 (2-10) at follow-up. The Kellgren-Lawrence score was normal in 17 (27 %), suspected osteoarthritis in 25 (40 %), minimal osteoarthritis in 5 (8 %), moderate osteoarthritis in 9 (14 %) and severe osteoarthritis in 3 patients (5 %). The femoral tunnel was in zone A in 43 patients (68 %), in zone B in 16 (25 %) and in zone C in 4 patients (7 %). The femoral tunnel position in percentage of the Blumensaat line was 49 ± 3 (range, 44-57), and the tibial tunnel position in percentage of the total anterior-posterior plateau length was 32 ± 6 (range, 21-46). Patients with meniscal lesion at the time of ACL tear showed significantly less favourable outcomes than those without.
Patients treated by the proposed ACL reconstruction technique showed on average good to excellent long-term results. A meniscal lesion at the time of ACL tear was highly predictive for less favourable outcome.
我们研究的主要目的是分析采用髌腱自体移植物解剖学单束 ACL 重建治疗前交叉韧带（ACL）撕裂患者的长期结果。次要目的是确定良好结果和发生骨关节炎的预测因素。
63 例（男：女=54：9；手术时平均年龄 27±7 岁）患者接受 ACL 重建，平均随访 16±1 年，采用 IKDC2000、SF36、Lysholm 和 Tegner 评分、膝关节协会评分、视觉模拟评分疼痛和满意度以及 KOOS 进行评估。根据 Sommer 评估股骨隧道位置。还根据 Blumensaat 线的百分比评估胫骨隧道位置和总前-后平台长度的百分比。根据 Kellgren-Lawrence 评分评估骨关节炎的程度。
20 例（32%）患者的总 IKDC2000 正常，29 例（46%）接近正常，12 例（19%）异常，3 例（5%）严重异常。平均总 SF-36 为 89±13，Lysholm 评分为 95±12，膝关节协会评分为 191±16，总 KOOS 为 84±19。Tegner 评分从受伤前的 7（4-10）降至随访时的 6（2-10）。17 例（27%）患者 Kellgren-Lawrence 评分正常，25 例（40%）疑似骨关节炎，5 例（8%）轻度骨关节炎，9 例（14%）中度骨关节炎，3 例（5%）严重骨关节炎。43 例（68%）患者股骨隧道位于 A 区，16 例（25%）患者股骨隧道位于 B 区，4 例（7%）患者股骨隧道位于 C 区。股骨隧道在 Blumensaat 线的百分比为 49±3（范围，44-57），胫骨隧道在总前-后平台长度的百分比为 32±6（范围，21-46）。ACL 撕裂时存在半月板损伤的患者的结果明显不如无半月板损伤的患者。
采用我们提出的 ACL 重建技术治疗的患者平均结果良好至优秀。ACL 撕裂时半月板损伤是预后较差的高度预测因素。
