Department of Sports Medicine, Shenzhen Second People's Hospital, No.3002, Sungang W. Road, Futian District, Shenzhen, 518035, People's Republic of China.
Int Orthop. 2013 Feb;37(2):233-8. doi: 10.1007/s00264-012-1764-6. Epub 2013 Jan 12.
Based on biomechanical cadaver studies, anatomical double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced to achieve better stability in the knee, particularly in respect of rotatory loads. Previously, the success of ACL reconstruction was believed to be mainly dependent on correct positioning of the graft, irrespective of the number of bundles for which computer-assisted surgery was developed to avoid malpositioning of the tunnel. The aim of this study was to compare rotational and translational stability after computer-navigated standard single-bundle and anatomical double-bundle ACL reconstruction.
The authors investigated 42 consecutive patients who had undergone the single-bundle or double-bundle ACL reconstruction procedure using autogenous hamstring tendon grafts and ENDOBUTTON fixation in patients who had been followed up for a minimum of 24 months. Post-operative anteroposterior and rotational laxity was measured with the KT3000 and compared between groups.
Both surgical procedures significantly improve rotational and translational stability compared to the preoperative ACL-deficient knee (P<0.05). No significant differences were registered between groups with regard to anteroposterior displacement of the tibia. The International Knee Documentation Committee (IKDC) and Lysholm scores were significantly higher in the double-bundle group. However, the results were excellent in both groups.
The use of computer-assisted ACL reconstruction, which is a highly accurate method of graft placement, could be useful for inexperienced surgeons to avoid malposition. Long-term results of at least five years are needed to determine whether double-bundle ACL reconstruction, which was associated with improved rotational laxity and significantly better IKDC and Lysholm scores compared to the standard single-bundle ACL reconstruction procedure, exerts an influence in terms of avoiding osteoarthritis or meniscus degeneration.
基于尸体生物力学研究，前交叉韧带（ACL）的解剖双束重建被引入，以实现膝关节更好的稳定性，特别是在旋转负荷方面。此前，ACL 重建的成功被认为主要取决于移植物的正确定位，而不管用于避免隧道错位的束数如何，计算机辅助手术都是如此。本研究的目的是比较计算机导航标准单束和解剖双束 ACL 重建后的旋转和平移稳定性。
作者调查了 42 例连续接受 ACL 单束或双束重建术的患者，均采用自体腘绳肌腱移植物和 ENDOBUTTON 固定，随访时间至少 24 个月。使用 KT3000 测量术后前后方向和旋转松弛度，并在组间进行比较。
与 ACL 缺失膝关节相比，两种手术均显著改善了旋转和平移稳定性（P<0.05）。两组间胫骨前后位移无显著差异。双束组的国际膝关节文献委员会（IKDC）和 Lysholm 评分显著更高。然而，两组的结果均为优。
使用计算机辅助 ACL 重建，这是一种高精度的移植物放置方法，对于经验不足的外科医生来说，可以避免错误定位。需要至少五年的长期结果来确定双束 ACL 重建是否会影响避免骨关节炎或半月板退变，因为它与改善的旋转松弛度以及与标准单束 ACL 重建术相比，显著更好的 IKDC 和 Lysholm 评分相关。
