Yoo Yon Sik, Song Si Young, Yang Cheol Jung, Ha Jong Mun, Kim Yoon Sang, Seo Young Jin
Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
HiLab, Korea University of Technology and Education, Cheonan, Korea.
Yonsei Med J. 2016 Sep;57(5):1199-208. doi: 10.3349/ymj.2016.57.5.1199.
The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle.
The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach.
The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all p<0.001). At last follow-up, mean side-to-side instrumented laxities measured by the KT-2000 and manual stress radiography were significantly improved from preoperative data in all groups (all p<0.001). There were no significant differences between the three groups in anterior instability measured by KT-2000 arthrometer, pivot shift, or functional scores.
Selective bundle reconstruction in partial ACL tears offers comparable clinical results to DB reconstruction in complete ACL tears.
本研究旨在比较关节镜下解剖双束（DB）前交叉韧带（ACL）重建与选择性前内侧（AM）或后外侧（PL）束重建在保留相对健康的ACL束时的临床结果。
作者评估了98例平均随访30.8±4.0个月的患者，这些患者接受了DB或选择性束ACL重建。其中，34例接受了DB ACL重建（A组），34例接受了选择性AM束重建（B组），30例接受了选择性PL束重建（C组）。比较这些组在Lysholm和国际膝关节文献委员会（IKDC）评分、在30磅力下用KT-2000关节测量仪测量的前侧松弛度的左右差异、应力X线摄影以及Lachman试验和轴移试验结果。术前和术后数据采用统计学方法进行客观评估。
A组在膝关节屈曲90°时通过手动应力X线摄影测量的术前前侧不稳定度显著高于B组和C组（均p<0.001）。在最后随访时，所有组通过KT-2000和手动应力X线摄影测量的平均左右仪器测量松弛度均较术前数据有显著改善（均p<0.001）。三组在通过KT-2000关节测量仪测量的前侧不稳定度、轴移或功能评分方面无显著差异。
部分ACL撕裂的选择性束重建与完全ACL撕裂的DB重建具有相当的临床结果。
