Legnani Claudio, Boisio Francesca, Borgo Enrico, Ventura Alberto
IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy.
Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milan, Italy.
Orthopade. 2019 Oct;48(10):858-861. doi: 10.1007/s00132-019-03779-6.
Lateral extra-articular procedures in association with anterior cruciate ligament (ACL) reconstruction can act as a protection against undesired loads occurring in the early postoperative phase. The purpose of the present study was to retrospectively review the clinical outcome of contralateral hamstring tendon autografts with extra-articular tenodesis for ACL revision surgery in skeletally mature patients under 25 years of age, specifically with respect to patient satisfaction, return to preinjury activity level and postoperative functional outcome.
In this study 9 patients (<25 years old at surgery) who underwent ACL revision surgery using contralateral hamstring tendon autografts and extra-articular tenodesis were contacted and retrospectively reviewed at an average follow-up of 3.6 years (range 2-7 years). The Tegner activity scale, Lysholm knee score and International Knee Documentation Committee (IKDC) questionnaire were used. Objective evaluation included range of motion, Lachmann test, pivot-shift test and KT-1000 instrumented laxity testing.
No cases of re-rupture were observed. The Lysholm knee score as well as the IKDC score improved at follow-up reaching a mean value of 87.9 and 85.6, respectively, with a statistically significant improvement compared to preoperative status (p < 0.001). In terms of knee stability anterior tibial translation has changed from a preoperative mean value of 5.4 mm to a postoperative value of 2.9 mm, which was statistically significant (p < 0.001). No subjective loss of motion or strength of the contralateral knee, rotational injuries following tendon harvesting or significant morbidity at follow-up were reported.
Revision ACL reconstruction with contralateral hamstrings and associated extra-articular tenodesis provides satisfying subjective outcomes and restores knee stability in skeletally mature patients under 25 years of age.
IV.
与前交叉韧带（ACL）重建联合进行的外侧关节外手术可防止术后早期出现不必要的负荷。本研究的目的是回顾性分析25岁以下骨骼成熟患者行对侧腘绳肌腱自体移植联合关节外腱固定术进行ACL翻修手术的临床结果，特别是患者满意度、恢复伤前活动水平和术后功能结果。
本研究联系了9例接受对侧腘绳肌腱自体移植联合关节外腱固定术进行ACL翻修手术的患者（手术时年龄<25岁），并进行回顾性分析，平均随访3.6年（范围2 - 7年）。采用Tegner活动量表、Lysholm膝关节评分和国际膝关节文献委员会（IKDC）问卷。客观评估包括活动范围、Lachmann试验、轴移试验和KT - 1000仪器测量的松弛度测试。
未观察到再断裂病例。随访时Lysholm膝关节评分和IKDC评分均有所改善，平均值分别达到87.9和85.6，与术前状态相比有统计学意义的改善（p < 0.001）。在膝关节稳定性方面，胫骨前移从术前的平均值5.4毫米变为术后的2.9毫米，具有统计学意义（p < 0.001）。未报告对侧膝关节主观活动或力量丧失、肌腱取材后的旋转损伤或随访时的严重并发症。
对侧腘绳肌腱联合相关关节外腱固定术进行ACL翻修重建，在25岁以下骨骼成熟患者中提供了令人满意的主观结果并恢复了膝关节稳定性。
IV级。
