Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
Orthop Traumatol Surg Res. 2019 Feb;105(1S):S89-S94. doi: 10.1016/j.otsr.2018.05.014. Epub 2018 Aug 18.
In anterior cruciate ligament (ACL) reconstruction, success depends on several factors: patient selection; surgical technique, taking account of associated meniscal and ligamentous lesions; and postoperative rehabilitation. Improved hamstring-tendon graft preparation and fixation techniques now provide results in terms of laxity and retear comparable to patellar tendon graft, which has long been the gold-standard for patients with strong functional demand, despite its higher risk of extension stiffness and anterior pain. Apart from a few exceptional preferential indications, such as hamstring tendon in growing children and patients whose lifestyle or occupation involves frequent kneeling and patellar tendon in case of severe medial laxity associated with ACL tear, either graft may be used for ACL reconstruction. The keypoints in the procedure are good tunnel positioning and hence good mastery of the surgical technique, and treatment of all associated lesions, and especially of occult meniscal lesions and rotational laxity due to anterolateral ligament deficiency, which requires associated extra-articular plasty. Graft choice is secondary and not a key to success.
在前交叉韧带（ACL）重建中，成功取决于几个因素：患者选择；手术技术，考虑到相关的半月板和韧带损伤；以及术后康复。改进的腘绳肌腱移植物准备和固定技术现在提供了在松弛度和再撕裂方面与髌腱移植物相当的结果，髌腱移植物长期以来一直是功能需求强烈的患者的金标准，尽管其伸直僵硬和前侧疼痛的风险更高。除了少数特殊的优先适应证，如生长中的儿童的腘绳肌腱和生活方式或职业涉及频繁跪地的患者，以及伴有 ACL 撕裂的严重内侧松弛的患者，髌腱可用于 ACL 重建。该手术的关键点是良好的隧道定位，因此需要很好地掌握手术技术，并治疗所有相关的病变，尤其是隐匿性半月板病变和由于前外侧韧带缺失引起的旋转松弛，这需要进行关节外整形。移植物的选择是次要的，不是成功的关键。
