Guo Lin, Chen Hao, Luo Jiang-Ming, Yang Liu, Gu Ling-Chuan, Fu De-Jie
Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
Arthroscopy. 2016 May;32(5):868-77. doi: 10.1016/j.arthro.2015.11.017. Epub 2016 Jan 25.
To assess the effects of preserved more anterior cruciate ligament (ACL) remnant on synovial coverage, knee stability, and function after bone patellar-tendon-bone (BPTB) allograft reconstruction through second-look arthroscopy and follow-up study.
From June 2007 to February 2009, 51 patients received single bundle BPTB allograft ACL reconstruction and second arthroscopic examination. The patients were divided into 4 types according to the types of ACL remnant: type 1, 18 had bridging between the posterior cruciate ligament and the tibia; type 2, 21 had bridging between the intercondylar notch roof and the tibia; type 3, 4 had bridging between the lateral condyle and the tibia; and type 4, 8 subjects had no ACL remnants. Clinical results were evaluated with the KT-1000 maximum displacement test and Lysholm scale at mean 12.3- and 53.5-month follow-up. Second-look synovium coverage was recorded as follows: covering 25% or less, 25% to 50%, 50% to 75%, and more than 75%.
Mean percentage of synovium coverage, Lysholm scale, and KT-1000 side-to-side difference were poorer in types 3 and 4 than the other 2 types at mean 12.3-month follow-up without statistical differences. The result of the final follow-up was comparable with the first one. Four patients had ruptured grafts and accepted revision surgery. Three of them belonged to types 3 and 4, and 1 patient with sport trauma belonged to type 2. There were other 11 patients with different types of impingement and partial absorption of grafts.
Although lack of statistical power, follow-up study and second-look arthroscopy showed that preserved type 3 and 4 ACL remnant caused poorer synovium coverage and might lead to earlier failure when using BPTB allograft. Early minor laxity at 12.3-month follow-up seemed to be not progressive at the final follow-up.
Level III, case-control study.
通过二次关节镜检查及随访研究，评估保留更多前交叉韧带（ACL）残端对骨-髌腱-骨（BPTB）同种异体移植重建术后滑膜覆盖、膝关节稳定性及功能的影响。
2007年6月至2009年2月，51例患者接受单束BPTB同种异体移植ACL重建及二次关节镜检查。根据ACL残端类型将患者分为4型：1型，18例后交叉韧带与胫骨之间有桥接；2型，21例髁间窝顶与胫骨之间有桥接；3型，4例外侧髁与胫骨之间有桥接；4型，8例无ACL残端。在平均12.3个月和53.5个月随访时，采用KT-1000最大位移试验和Lysholm量表评估临床结果。二次关节镜检查时记录滑膜覆盖情况如下：覆盖25%及以下、25%至50%、50%至75%、超过75%。
在平均12.3个月随访时，3型和4型的滑膜覆盖平均百分比、Lysholm量表评分及KT-1000两侧差值均比其他2型差，但无统计学差异。最终随访结果与首次随访结果相当。4例患者移植体断裂并接受翻修手术。其中3例属于3型和4型，1例运动创伤患者属于2型。另有11例患者存在不同类型的撞击及移植体部分吸收。
尽管缺乏统计学效力，但随访研究及二次关节镜检查显示，保留3型和4型ACL残端导致滑膜覆盖较差，使用BPTB同种异体移植时可能导致更早失败。12.3个月随访时早期轻度松弛在最终随访时似乎无进展。
III级，病例对照研究。
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