Kong Ying, Zhang Yuanmin, Zhao Xiaowei
Department of Bone and Joint Surgery, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Sep;27(9):1037-40.
To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy.
Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 +/- 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved.
Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 +/- 2.0, showing significant difference when compared with preoperative score (t = -34.32, P = 0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z = -5.57, P = 0.00).
Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.
探讨关节镜下保留残端自体四股腘绳肌腱重建后交叉韧带（PCL）的有效性。
2007年10月至2012年8月，对32例PCL断裂患者进行治疗并随访1年以上。其中男24例，女8例，年龄20 - 53岁（平均35.6岁）。损伤原因包括交通事故伤21例，运动损伤8例，高处坠落伤3例。病程1周至2年（中位数6.3周）。单纯PCL断裂9例，合并韧带损伤23例，其中前交叉韧带断裂10例，后外侧角损伤11例，后内侧角损伤2例。术前Lysholm评分为53.8±7.1。根据国际膝关节文献委员会（IKDC）评分标准，C级10例，D级22例。采用自体四股腘绳肌腱重建PCL，股骨侧用EndoButton固定，胫骨侧用挤压螺钉固定；清理残端的漂浮物，保留韧带残端的结构稳定性和连续性。
所有切口均一期愈合；术后无早期并发症发生。32例患者平均随访23.4个月（范围12 - 36个月）。所有患者均无膝关节不稳症状；胫骨沉降征、后抽屉试验及Lachman试验结果均为阴性。末次随访时，所有病例膝关节活动度（ROM）均恢复正常。Lysholm评分为92.3±2.0，与术前评分比较差异有统计学意义（t = -34.32，P = 0.00）。根据IKDC评分标准，末次随访时A级26例，B级6例，与术前分级比较差异有统计学意义（Z = -5.57，P = 0.00）。
关节镜下单束保留残端四股腘绳肌腱重建PCL具有创伤小、操作简单、膝关节功能恢复良好的优点。
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