采用 Tape Locking Screw（TLS）和半腱肌肌腱重建前交叉韧带：61 例至少随访 12 个月的临床评估。
Anterior cruciate ligament reconstruction with the Tape Locking Screw (TLS) and a short hamstring graft: Clinical evaluation of 61 cases with a minimum 12 months' follow-up.
机构信息
Service de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble-Alpes, 38130 Échirolles, France.
Service de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble-Alpes, 38130 Échirolles, France.
出版信息
Orthop Traumatol Surg Res. 2018 Sep;104(5):701-705. doi: 10.1016/j.otsr.2018.03.016. Epub 2018 Jun 28.
INTRODUCTION
The Tape Locking Screw (TLS technique for anterior cruciate ligament (ACL) reconstruction has the advantages of using only one hamstring tendon (semitendinosus) by preparing a short graft secured with screws and braided strips. The theoretical pitfall of this technique is that the graft length is determined arbitrarily. Thus, if the blind tunnels are not long enough, it will be impossible to tension the graft properly upon fixation. The primary objective of this study was to determine the postoperative side-to-side difference in knee laxity. We hypothesized that ACL reconstruction with the TLS(R) system would result in 3mm or less side-to-side difference in knee laxity.
MATERIAL AND METHODS
This was a prospective single-center, single-surgeon study performed on patients operated between December 2014 and June 2016 who had a minimum 12 months' follow-up. The pre- and post-operative side-to-side difference in knee laxity was measured with a KT-1000 arthrometer. Secondary outcomes were the pre- and post-operative IKDC, Lysholm and Tegner functional scores.
RESULTS
Sixty-one patients were included: 49 men (80%) and 12 women (20%). The average age was 31.6±13.7 years. The average follow-up was 19.3±6.3 months. The average side-to-side difference in laxity went from 6.5mm (min 3; max 12) preoperatively to -0.1mm postoperatively (min -5, max 4) (p<0.01). The average IKDC went from 39.7±12 preoperatively to 94.1±11.2 postoperatively (p<0.005), the average Lysholm score went from 41±12.9 to 95.5±9.8 (p<0.005), and the average Tegner score went from 6.3±1.5 to 4.3±1.4 (p<0.005). Patients were able to return to sports an average of 6.1 months after surgery. In terms of complications, 4.9% of patients developed a cyclops lesion and required surgical revision.
DISCUSSION
This study found very good reduction in postoperative laxity after a minimum 12 months' follow-up when ACL reconstruction is performed with the TLS technique.
LEVEL OF EVIDENCE
IV, prospective cohort study.
介绍
前交叉韧带（ACL）重建的带线锁定螺钉（TLS 技术）具有使用一条半腱肌腱（半腱肌）的优点，通过制备短移植物并用螺钉和编织条固定。该技术的理论缺陷是移植物长度是任意确定的。因此，如果盲隧道不够长，则无法在固定时适当拉紧移植物。本研究的主要目的是确定术后膝关节松弛的侧别差异。我们假设使用 TLS(R)系统进行 ACL 重建将导致膝关节松弛的侧别差异为 3mm 或更小。
材料与方法
这是一项前瞻性单中心、单术者研究，对 2014 年 12 月至 2016 年 6 月期间接受手术且随访时间至少 12 个月的患者进行。使用 KT-1000 关节测量仪测量术前和术后膝关节松弛的侧别差异。次要结局是术前和术后的 IKDC、Lysholm 和 Tegner 功能评分。
结果
共纳入 61 例患者：49 例男性（80%）和 12 例女性（20%）。平均年龄为 31.6±13.7 岁。平均随访时间为 19.3±6.3 个月。松弛的侧别差异平均从术前的 6.5mm（最小 3；最大 12）变为术后的-0.1mm（最小-5，最大 4）（p<0.01）。IKDC 平均从术前的 39.7±12 变为术后的 94.1±11.2（p<0.005），Lysholm 评分从 41±12.9 变为 95.5±9.8（p<0.005），Tegner 评分从 6.3±1.5 变为 4.3±1.4（p<0.005）。术后平均 6.1 个月患者即可重返运动。在并发症方面，4.9%的患者出现了单髁病变，需要手术修复。
讨论
本研究发现，在前交叉韧带重建中使用 TLS 技术，至少 12 个月的随访后，术后松弛度得到了非常好的降低。
证据等级
IV，前瞻性队列研究。
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