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关节镜下解剖双束前交叉韧带重建:我们4年的随访经验。

Arthroscopic anatomic double bundle anterior cruciate ligament reconstruction: Our experience with follow-up of 4 years.

作者信息

Morey Vivek Machhindra, Nag Hira Lal, Chowdhury Buddhadev, Pannu Chaitanya Dev, Meena Sanjay, Kumar Kiran, Palaniswamy Aravindh

机构信息

Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

出版信息

J Clin Orthop Trauma. 2016 Jan-Mar;7(1):17-22. doi: 10.1016/j.jcot.2015.06.003. Epub 2015 Jul 20.

Abstract

BACKGROUND

Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction.

PURPOSE

To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population.

METHODS

We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores.

RESULTS

At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively.

CONCLUSION

Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.

摘要

背景

双束(DB)前交叉韧带(ACL)重建术旨在重现ACL的自然解剖结构。人们认为重建ACL两束的解剖结构能够恢复膝关节的旋转稳定性。然而,DB重建术的功能结局是否优于单束(SB)ACL重建术仍不明确。

目的

评估印度人群中接受DB ACL重建术治疗的患者的临床结局、患者满意度以及膝关节的手动松弛度测试结果。

方法

我们在应用纳入和排除标准后,对25例孤立性ACL损伤且接受DB ACL重建术的患者进行了前瞻性随访。对患者进行术前和术后定期评估,最短随访时间为4年。通过前抽屉试验、Lachman试验和轴移试验评估临床稳定性。通过国际膝关节文献委员会(IKDC)、Lysholm评分和改良辛辛那提评分评估功能结局。

结果

在4年随访结束时,所有主观评分方面的功能结局均令人满意。Lachman试验、前抽屉试验和轴移试验的分级稳定性结果几乎接近正常膝关节。术后未发生并发症。

结论

对于ACL撕裂患者,解剖学DB ACL重建术在主观评分和稳定性测试方面似乎能提供令人满意的结果。已发现其无明显并发症且无失败病例。然而,需要更大的患者群体才能得出确定性结果。

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Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction.双束重建比单束重建的临床效果更好。
Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1085-96. doi: 10.1007/s00167-012-2073-8. Epub 2012 Jun 7.
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Surgery for anterior cruciate ligament deficiency: a historical perspective.前交叉韧带缺失的手术治疗:历史回顾。
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A long journey to be anatomic.成为解剖学专家的漫长征程。
Knee Surg Sports Traumatol Arthrosc. 2010 Sep;18(9):1151-3. doi: 10.1007/s00167-010-1222-1.

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