解剖学前交叉韧带重建：减少胫骨前移
Anatomic anterior cruciate ligament reconstruction: reducing anterior tibial subluxation.
作者信息
Muller Bart, Duerr Eric R H, van Dijk C Niek, Fu Freddie H
机构信息
Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):3005-3010. doi: 10.1007/s00167-015-3612-x. Epub 2015 Apr 26.
PURPOSE
To measure and compare the amount of anterior tibial subluxation (ATS) after anatomic ACL reconstruction for both acute and chronic ACL-deficient patients.
METHODS
Fifty-two patients were clinically and radiographically evaluated after primary, unilateral, anatomic ACL reconstruction. Post-operative true lateral radiographs were obtained of both knees with the patient in supine position and knees in full passive extension with heels on a standardized bolster. ATS was measured on the radiographs by two independent and blinded observers. ATS was calculated as the side-to-side difference in tibial position relative to the femur. An independent t test was used to compare ATS between those undergoing anatomic reconstruction for an acute versus chronic ACL injury. Chronic ACL deficiency was defined as more than 12 weeks from injury to surgery.
RESULTS
Patients averaged 26.4 ± 11.5 years (mean ± SD) of age, 43.6 % were female, and 48.1 % suffered an injury of the left knee. There were 30 and 22 patients in the acute and chronic groups, respectively. The median duration from injury to reconstruction for the acute group was 5 versus 31 weeks for the chronic group. After anatomic ACL reconstruction, the mean ATS was 1.0 ± 2.1 mm. There was no statistical difference in ATS between the acute and chronic groups (1.2 ± 2.0 vs. 0.6 ± 2.3 mm, n.s.). Assessment of inter-tester reliability for radiographic evaluation of ATS revealed an excellent intraclass correlation coefficient of 0.894.
CONCLUSIONS
Anatomic ACL reconstruction reduces ATS with a mean difference of 1.0 mm from the healthy contralateral limb. This study did not find a statistical difference in ATS between patients after anatomic ACL reconstruction in the acute or chronic phase. These observations suggest that anatomic ACL reconstruction, performed in either the acute or the chronic phase, approaches the normal AP relationship of the tibiofemoral joint.
LEVEL OF EVIDENCE
IV.
目的
测量并比较急性和慢性前交叉韧带（ACL）损伤患者在进行解剖学ACL重建术后的胫骨前移半脱位（ATS）量。
方法
52例患者在初次单侧解剖学ACL重建术后接受了临床和影像学评估。术后让患者仰卧位，双膝关节完全被动伸直，足跟置于标准垫枕上，获取双膝关节的真实侧位X线片。由两名独立且不知情的观察者在X线片上测量ATS。ATS计算为胫骨相对于股骨位置的双侧差异。采用独立样本t检验比较急性与慢性ACL损伤患者在解剖学重建术后的ATS。慢性ACL损伤定义为从受伤至手术超过12周。
结果
患者平均年龄为26.4±11.5岁（均值±标准差），43.6%为女性，48.1%为左膝受伤。急性组和慢性组分别有30例和22例患者。急性组从受伤至重建的中位时间为5周，慢性组为31周。解剖学ACL重建术后，平均ATS为1.0±2.1mm。急性组和慢性组之间的ATS无统计学差异（1.2±2.0 vs. 0.6±2.3mm，无显著性差异）。对ATS影像学评估的检验者间可靠性评估显示，组内相关系数极佳，为0.894。
结论
解剖学ACL重建可减少ATS，与对侧健康肢体相比平均差异为1.0mm。本研究未发现急性或慢性期解剖学ACL重建术后患者之间的ATS存在统计学差异。这些观察结果表明，在急性或慢性期进行的解剖学ACL重建可使胫股关节接近正常的前后关系。
证据级别
IV级
Zotero 插件