Department of Orthopaedic Surgery, Jhong Jheng Orthopedic Hospital, Kaohsiung, Taiwan.
Arthroscopy. 2013 Sep;29(9):1525-32. doi: 10.1016/j.arthro.2013.06.005. Epub 2013 Jul 30.
PURPOSE: The purpose of this study was to compare the functional outcome, ligament laxity, and tibial tunnel enlargement between 3-tunnel double-bundle (DB) anterior cruciate ligament (ACL) and single-bundle (SB) ACL reconstruction. METHODS: This retrospective study identified primary arthroscopic ACL reconstruction from July 2006 to July 2008. The cohort consisted of 50 knees in 49 patients, comprising 26 knees with SB ACL reconstruction and 24 with DB ACL reconstruction. Semitendinosus autograft was used in SB ACL reconstruction, and semitendinosus and gracilis grafts were used in DB ACL reconstruction. Both groups received the same rehabilitation protocol postoperatively. The evaluations included functional assessment, ligament laxity, and radiographs of the knee. Functional assessments included a pain score, the Lysholm functional score, the Tegner activity score, and the grade on the International Knee Documentation Committee knee examination form. Ligament laxity was measured by the anterior drawer test, Lachman test, pivot-shift test, and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. It was graded as 0 for no laxity, 0 to 5 mm for mild laxity, 5 to 10 mm for moderate laxity, and 10 to 15 mm for severe laxity. Radiographs of the knee were used for the evaluation of bony appearance, alignment of the knee, joint space narrowing, and measurement of the tibial tunnel. RESULTS: Significant improvements in knee function and ligament laxity were noted after surgery in both groups. However, no statistical differences in functional scores and ligament laxity were noted between the 2 groups (P = .275 and P = .413, respectively). A mild increase in laxity was noted in 3 cases (14%) in the DB ACL reconstruction group and 3 cases (13%) in the SB ACL reconstruction group. A moderate increase in laxity was noted in 2 cases (9%) in the SB ACL reconstruction group and none in the DB ACL reconstruction group. Radiographic evaluations showed no statistical difference between the 2 groups (P = .114). CONCLUSIONS: Both 3-tunnel Y-graft DB ACL reconstruction and SB ACL reconstruction significantly improved the function and stability of the knee after surgery. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
目的：本研究旨在比较 3 隧道双束（DB）前交叉韧带（ACL）与单束（SB）ACL 重建的功能结果、韧带松弛度和胫骨隧道扩大情况。
方法：本回顾性研究于 2006 年 7 月至 2008 年 7 月期间，对初次关节镜 ACL 重建患者进行了回顾性分析。该队列包括 49 例患者的 50 个膝关节，其中 26 个膝关节行 SB ACL 重建，24 个膝关节行 DB ACL 重建。SB ACL 重建中使用半腱肌自体移植物，DB ACL 重建中使用半腱肌和股薄肌移植物。两组患者术后均接受相同的康复方案。评估包括功能评估、韧带松弛度和膝关节 X 线检查。功能评估包括疼痛评分、Lysholm 功能评分、Tegner 活动评分和国际膝关节文献委员会膝关节检查表的评分。韧带松弛度通过前抽屉试验、lachman 试验、枢轴转移试验和 KT-1000 关节测量仪（MEDmetric，圣地亚哥，CA）进行测量，分为无松弛（0 级）、轻度松弛（0-5mm，1 级）、中度松弛（5-10mm，2 级）和重度松弛（10-15mm，3 级）。膝关节 X 线用于评估骨骼外观、膝关节对线、关节间隙变窄和胫骨隧道测量。
结果：两组患者术后膝关节功能和韧带松弛度均显著改善，但两组间功能评分和韧带松弛度无统计学差异（P=0.275 和 P=0.413）。DB ACL 重建组 3 例（14%）和 SB ACL 重建组 3 例（13%）出现轻度松弛增加。SB ACL 重建组 2 例（9%）出现中度松弛增加，DB ACL 重建组无中度松弛增加。两组间 X 线评估无统计学差异（P=0.114）。
结论：3 隧道 Y 型移植物 DB ACL 重建和 SB ACL 重建均可显著改善术后膝关节的功能和稳定性。
证据水平：IV 级，治疗性病例系列研究。
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