Saito Kenichi, Hatayama Kazuhisa, Terauchi Masanori, Hagiwara Keiichi, Higuchi Hiroshi, Takagishi Kenji
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; Department of Orthopaedic Surgery, Japan Community Health Care Organization, Gunma Central Hospital, Maebashi, Gunma, Japan.
Department of Orthopaedic Surgery, Japan Community Health Care Organization, Gunma Central Hospital, Maebashi, Gunma, Japan.
Arthroscopy. 2015 Jul;31(7):1310-7. doi: 10.1016/j.arthro.2015.01.022. Epub 2015 Mar 19.
The aim of this study was to compare postoperative outcomes after anatomic double-bundle anterior cruciate ligament reconstruction (ACLR) in extreme knee hyperextension versus normal to mild knee hyperextension.
For 100 patients who underwent anatomic double-bundle ACLR using semitendinosus tendon, we evaluated the side-to-side difference (SSD) in anterior tibial translation (measured on stress radiographs) and rotational stability (assessed by the pivot-shift test) 2 years after surgery. Loss of extension (LOE) was evaluated on lateral radiographs of both knees in full extension, and graft integrity was assessed during second-look arthroscopy 1 to 2 years after surgery. In accordance with the Beighton and Honan criteria, patients with an extension angle less than or equal to 10° in the contralateral uninjured knee composed the group with 10° or less hyperextension (N group), and those with an extension angle of greater than 10° composed the group with more than 10° hyperextension (H group). Postoperative results were compared between these groups.
Mean extension angles in the N and H groups were 5.8° ± 2.9° and 14.7° ± 3.0°, respectively. The mean SSD in anterior translation was 2.2 ± 2.9 mm for the N group and 2.8 ± 2.9 mm for the H group, with no significant difference. The positive ratios on the pivot-shift test were not significantly different between the groups. Mean LOE in the N and H groups was -0.7° ± 3.7° and 1.3° ± 3.3°, respectively, with a significant difference (P = .007). During second-look arthroscopy, 6 of 58 knees in the N group and 13 of 42 knees in the H group had superficial graft laceration of the anteromedial bundle graft, with a significant difference (P = .01) seen between groups.
Anatomic double-bundle ACLR for extreme knee hyperextension may attain the same postoperative anterior and rotational stability as seen in knees with normal to mild hyperextension. However, it increased superficial graft laceration.
Level III, retrospective comparative study.
本研究旨在比较极度膝关节过伸与正常至轻度膝关节过伸患者在解剖双束前交叉韧带重建（ACLR）术后的结果。
对于100例行半腱肌腱解剖双束ACLR的患者，我们在术后2年评估了胫骨前移的左右侧差异（通过应力X线片测量）和旋转稳定性（通过轴移试验评估）。在双膝关节完全伸直的侧位X线片上评估伸直丢失（LOE），并在术后1至2年的二次关节镜检查时评估移植物完整性。根据Beighton和Honan标准，对侧未受伤膝关节伸直角度小于或等于10°的患者组成10°或以下过伸组（N组），伸直角度大于10°的患者组成超过10°过伸组（H组）。比较两组的术后结果。
N组和H组的平均伸直角度分别为5.8°±2.9°和14.7°±3.0°。N组和H组的平均胫骨前移左右侧差异分别为2.2±2.9mm和2.8±2.9mm，无显著差异。两组轴移试验的阳性率无显著差异。N组和H组的平均LOE分别为-0.7°±3.7°和1.3°±3.3°，差异有统计学意义（P = 0.007）。在二次关节镜检查时，N组58例膝关节中有6例、H组42例膝关节中有13例出现前内侧束移植物表面撕裂，两组间差异有统计学意义（P = 0.01）。
极度膝关节过伸患者行解剖双束ACLR术后，其前向和旋转稳定性可能与正常至轻度过伸膝关节相同。然而，这增加了移植物表面撕裂的发生率。
III级，回顾性比较研究。
