Koga Hideyuki, Muneta Takeshi, Yagishita Kazuyoshi, Watanabe Toshifumi, Mochizuki Tomoyuki, Horie Masafumi, Nakamura Tomomasa, Otabe Koji, Sekiya Ichiro
Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
Arthroscopy. 2015 Jan;31(1):69-76. doi: 10.1016/j.arthro.2014.07.020. Epub 2014 Sep 18.
To evaluate the mid-to long-term results of a randomized controlled trial of single-bundle (SB) versus double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a semitendinosus tendon.
Seventy-eight patients who underwent primary ACL reconstruction with an autologous semitendinosus tendon were prospectively randomized into 2 groups: SB reconstruction (n = 39) and DB reconstruction (n = 39). In both groups, grafts were fixed at 30° of flexion with a total tension of 80 N. The following evaluation methods were used: clinical examination, KT-1000 arthrometer (MEDmetric, San Diego, CA) measurement, muscle strength, Tegner activity score, Lysholm score, subjective rating scale regarding patient satisfaction and sports performance level, graft retear, contralateral ACL tear, and additional meniscus surgery.
Fifty-three patients (25 in SB group and 28 in DB group) who were followed up for a minimum of 3 years (mean, 69 months; range, 36 to 140 months) were evaluated. Preoperatively, there were no differences between the groups. Postoperatively, the Lachman and pivot-shift test results were better in the DB group (P = .024 and P < .0001, respectively). KT measurements were better in the DB group (mean, 1.4 mm v 2.7 mm; P = .0023). The Tegner score was also better in the DB group (P = .033). There were no significant differences in range of motion, muscle strength, Lysholm score, subjective rating scale, graft retear, and secondary meniscal tear.
In ACL reconstruction using the transtibial approach, DB reconstruction was significantly better than SB reconstruction regarding anterior and rotational stability during the 3- to 12-year follow-up. The results of KT measurements and the Lachman and pivot-shift tests were significantly better in the DB group, whereas there was no difference in the anterior drawer test results. The Tegner score was also better in the DB group; however, there were no differences in the other subjective findings.
Level II, lesser-quality prospective randomized trial.
评估采用半腱肌肌腱进行单束（SB）与双束（DB）前交叉韧带（ACL）重建的随机对照试验的中长期结果。
78例接受自体半腱肌肌腱初次ACL重建的患者被前瞻性随机分为两组：SB重建组（n = 39）和DB重建组（n = 39）。两组均在屈膝30°时以80 N的总张力固定移植物。采用以下评估方法：临床检查、KT-1000关节测量仪（MEDmetric，圣地亚哥，加利福尼亚州）测量、肌肉力量、Tegner活动评分、Lysholm评分、关于患者满意度和运动表现水平的主观评分量表、移植物再撕裂、对侧ACL撕裂以及额外的半月板手术。
对至少随访3年（平均69个月；范围36至140个月）的53例患者（SB组25例，DB组28例）进行了评估。术前，两组之间无差异。术后，DB组的Lachman试验和轴移试验结果更好（分别为P = 0.024和P < 0.0001）。DB组的KT测量结果更好（平均1.4 mm对2.7 mm；P = 0.0023）。DB组的Tegner评分也更好（P = 0.033）。在活动范围、肌肉力量、Lysholm评分、主观评分量表、移植物再撕裂和继发性半月板撕裂方面无显著差异。
在采用经胫骨入路的ACL重建中，在3至12年的随访期间，DB重建在前方和旋转稳定性方面明显优于SB重建。DB组的KT测量结果以及Lachman试验和轴移试验结果明显更好，而前抽屉试验结果无差异。DB组的Tegner评分也更好；然而，在其他主观结果方面无差异。
II级，质量较低的前瞻性随机试验。
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