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前交叉韧带部分撕裂患者后外侧束增强术的临床结果及生物力学分析

Clinical outcomes and biomechanical analysis of posterolateral bundle augmentation in patients with partial anterior cruciate ligament tears.

作者信息

Matsushita Takehiko, Kuroda Ryosuke, Nishizawa Yuichiro, Araki Daisuke, Hoshino Yuichi, Nagai Kanto, Matsumoto Tomoyuki, Kurosaka Masahiro

机构信息

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1279-1289. doi: 10.1007/s00167-015-3691-8. Epub 2015 Jul 11.

Abstract

PURPOSE

To examine the clinical and biomechanical results of posterolateral (PL) augmentation to reconstruct damaged PL bundle while preserving the less-damaged anteromedial bundle for partial anterior cruciate ligament (ACL) tears in comparison with double-bundle ACL reconstruction.

METHODS

Sixteen patients who underwent PL augmentation for partial ACL tears (Group P) and 37 patients who underwent double-bundle ACL reconstructions for complete ACL tears were examined (Group D). Anterior tibial translation (ATT) was evaluated using the KT-1000 arthrometer. ATT during the Lachman test and acceleration of posterior tibial translation (APT) during the pivot shift test were evaluated using an electromagnetic measurement system (EMS). Clinical outcomes were evaluated using the Lysholm score. Second-look arthroscopy was performed 1 year after surgery.

RESULTS

The mean postoperative Lysholm scores were 91.7 ± 12.2 and 94.6 ± 7.2 in Groups P and D, respectively, and there was no statistically significant difference between the two groups. The mean side-to-side difference of ATT on the KT-1000 was significantly improved in both Groups P and D. In the EMS analysis, the mean side-to-side difference of ATT and the mean APT were significantly improved in both Groups P and D. There was no significant difference in the second-look evaluation between the two groups.

CONCLUSIONS

The clinical and biomechanical outcomes of PL augmentation were satisfactorily comparable to those of double-bundle ACL reconstruction. PL augmentation could be a useful treatment option for patients with partial ACL tears.

LEVEL OF EVIDENCE

IV.

摘要

目的

与双束前交叉韧带(ACL)重建相比,研究后外侧(PL)增强术重建受损PL束同时保留损伤较轻的前内侧束用于部分ACL撕裂的临床和生物力学结果。

方法

检查了16例接受PL增强术治疗部分ACL撕裂的患者(P组)和37例接受双束ACL重建治疗完全ACL撕裂的患者(D组)。使用KT-1000关节测量仪评估胫骨前移(ATT)。使用电磁测量系统(EMS)评估Lachman试验中的ATT以及 pivot shift试验中胫骨后移加速度(APT)。使用Lysholm评分评估临床结果。术后1年进行二次关节镜检查。

结果

P组和D组术后Lysholm评分均值分别为91.7±12.2和94.6±7.2,两组间无统计学显著差异。两组中KT-1000上ATT的平均左右差值均显著改善。在EMS分析中,两组中ATT的平均左右差值和平均APT均显著改善。两组间二次关节镜检查评估无显著差异。

结论

PL增强术的临床和生物力学结果与双束ACL重建的结果具有令人满意的可比性。PL增强术可能是部分ACL撕裂患者的一种有用治疗选择。

证据级别

IV级。

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