Wu Haobo, Ma Chiyuan, Xiong Yan, Yan Shigui, Wu Lidong, Wu Weigang
Department of Orthopedics Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88th Jiefang Road, Hangzhou, 310000, China.
Arch Orthop Trauma Surg. 2018 Jun;138(6):827-834. doi: 10.1007/s00402-018-2909-x. Epub 2018 Mar 5.
To compare the clinical outcomes of double-bundle (DB) single-tibial tunnel technique and double-tunnel technique for ACL reconstruction in patients with knee hyperextension.
Defined as having constitutional hyperextension of greater than 10°, 56 patients with knee hyperextension who underwent ACL reconstruction were included in this study. To exclude concomitant lesions, preoperative magnetic resonance imaging (MRI) was performed in all knees. 24 patients (Group A) were treated with the anatomic DB/single-tibial tunnel ACL reconstruction and 32 patients (Group B) were treated with DB/double-tibial tunnel ACL reconstruction, all the included patients had knee hyperextension. Clinical results were evaluated by the extension angle, ROM, IKDC 2000 subjective score, rotational stability, pivot-shift test and anterior-posterior translation test before the operation and at the end of follow-up. MRI scan of the knee positioned in full extension was performed after 6 months post-operation. Location of tibial tunnels and graft signal intensity were assessed according to the MRI.
Postoperative extension deficit was detected in Group B, ROM of the injured knee in Group A was from extension angle 8.91 ± 3.16° to flexion angle 115.58 ± 10.53°. ROM of the injured knee in Group B was from extension angle - 2.13 ± 5.88° to flexion angle 119.25 ± 12.63°. Flexion angles of two groups did not show any significant difference (p = 0.24), while extension angles were quite different (p < 0.0001). Group A was slightly higher than Group B in IKDC subjective scores, but without significant difference (Group A 45.1 ± 6.5, Group B 42.4 ± 4.8, p = 0.09). There was no significant difference between two groups in pivot-shift test. Post-operational MRI showed more anterior located tibial tunnel and higher graft signal intensity in Group B when compared with Group A. One patient in the Group B had ligament retear, and required revision surgery.
DB/single-tibial tunnel technique restored the knee stability and overcame the shortcomings (such as knee extension deficit and graft impingement) of DB/double tibial tunnel, which might be more suitable for ACL reconstruction in knees with hyperextension.
Level II to III.
比较双束单胫骨隧道技术与双隧道技术在膝关节过度伸展患者中进行前交叉韧带重建的临床效果。
本研究纳入56例膝关节过度伸展且前交叉韧带重建的患者，定义为生理性膝关节过度伸展大于10°。为排除合并损伤，对所有膝关节均进行术前磁共振成像（MRI）检查。24例患者（A组）采用解剖双束/单胫骨隧道前交叉韧带重建术，32例患者（B组）采用双束/双胫骨隧道前交叉韧带重建术，所有纳入患者均有膝关节过度伸展。通过术前及随访结束时的伸展角度、活动范围（ROM）、IKDC 2000主观评分、旋转稳定性、轴移试验和前后平移试验评估临床结果。术后6个月对膝关节进行完全伸展位的MRI扫描。根据MRI评估胫骨隧道位置及移植物信号强度。
B组术后出现伸展功能障碍，A组患侧膝关节ROM从伸展角度8.91±3.16°至屈曲角度115.58±10.53°。B组患侧膝关节ROM从伸展角度-2.13±5.88°至屈曲角度119.25±12.63°。两组的屈曲角度无显著差异（p=0.24），而伸展角度差异较大（p<0.0001）。A组的IKDC主观评分略高于B组，但无显著差异（A组45.1±6.5，B组42.4±4.8，p=0.09）。两组在轴移试验中无显著差异。术后MRI显示，与A组相比，B组胫骨隧道位置更靠前，移植物信号强度更高。B组有1例患者韧带再次撕裂，需进行翻修手术。
双束单胫骨隧道技术恢复了膝关节稳定性，克服了双束双胫骨隧道技术的缺点（如膝关节伸展功能障碍和移植物撞击），可能更适合膝关节过度伸展患者的前交叉韧带重建。
II级至III级。
