前交叉韧带部分撕裂。

Partial tears of the anterior cruciate ligament.

作者信息

Sonnery-Cottet B, Colombet P

机构信息

Générale de santé, hôpital privé Jean-Mermoz, centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.

Clinique du Sport, 2, rue Negrevergne, 33700 Merignac, France.

出版信息

Orthop Traumatol Surg Res. 2016 Feb;102(1 Suppl):S59-67. doi: 10.1016/j.otsr.2015.06.032. Epub 2016 Jan 18.

Abstract

Partial anterior cruciate ligament (ACL) tears were first described nearly fifty years ago but the optimal treatment for these injuries continues to be a subject of considerable debate. A question remains whether it is advantageous to preserve the ACL remnant and augment it with a graft, or to debride it and proceed with a standard ACL reconstruction unhindered by remnant fibers in the notch. Clinical outcomes of bundle preserving surgery are promising. An increasingly large body of scientific evidence suggests that augmenting the intact bundle is beneficial in terms of vascularity, proprioception and kinematics. With this knowledge, a number of surgeons have developed techniques to augment the intact bundle of the ACL in partial tears and to biologically enhance standard reconstruction techniques by preserving the ACL remnant. Correct tunnel placement is critical for achieving successful short and long-term outcomes after ACL reconstruction. However, published studies have several limitations including a limited number of patients and lack of control groups for direct comparison of outcomes. Concerns continue to exist with respect to an increased risk of impingement following augmentation, responsible of cyclops syndrome. The objective of this article was to outline the diagnostic approach, describe a reproducible and simple surgical procedure that allows correct femoral tunnel placement without the need for aggressive notch debridement and report the clinical outcome of partial ACL reconstruction.

摘要

部分前交叉韧带(ACL)撕裂在近五十年前首次被描述,但这些损伤的最佳治疗方法仍然是一个备受争议的话题。一个问题仍然存在,即保留ACL残端并用移植物增强它,还是清理残端并进行标准的ACL重建,不受髁间窝残余纤维的阻碍,哪种方法更具优势。保留束支手术的临床效果很有前景。越来越多的科学证据表明,增强完整束支在血管生成、本体感觉和运动学方面是有益的。基于这一认识,一些外科医生已经开发出技术来增强部分撕裂的ACL完整束支,并通过保留ACL残端从生物学角度改进标准重建技术。正确的隧道放置对于ACL重建术后获得成功的短期和长期效果至关重要。然而,已发表的研究存在一些局限性,包括患者数量有限以及缺乏用于直接比较结果的对照组。对于增强术后撞击风险增加(与独眼巨人综合征有关)的担忧仍然存在。本文的目的是概述诊断方法,描述一种可重复且简单的手术操作,该操作无需积极清理髁间窝即可实现正确的股骨隧道放置,并报告部分ACL重建的临床结果。

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