Ding Yunpeng, Zhang Yadong, Jia Haigang, Gu Dongqiang, Chen Lei
Department of Joint and Sports Medicine, the Fourth Medical Center of General Hospital of Chinese PLA, Beijing, 100048, P.R.China.
Department of Joint and Sports Medicine, the Fourth Medical Center of General Hospital of Chinese PLA, Beijing, 100048,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Sep 15;33(9):1071-1076. doi: 10.7507/1002-1892.201904006.
To summarize the mid-term effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction combined with meniscus allograft transplantation.
A clinical data of 21 patients treated with arthroscopic ACL reconstruction and meniscus allograft transplantation and followed up more than 5 years between February 2007 and December 2014 was retrospectively analyzed. There were 12 males and 9 females, aged from 18 to 45 years, with an average age of 23.5 years. The cause of injury was sport sprain in 15 cases, falling in 4 cases, and traffic accident in 2 cases. The time from injury to operation ranged from 2 to 36 months, with an average of 12 months. Among them, 15 patients underwent previous meniscectomy, with an average interval of 1.6 years (range, 3 months to 6.5 years). All patients were primary ACL reconstruction. Preoperative anterior drawer test, Lachman test, and pivot shift test were positive. Lysholm score was 43.6±10.2. International Knee Documentation Committee (IKDC) score was 60.50±14.06. Of the 21 patients, 10 were gradeⅠ-Ⅱcartilage injuries and 11 were grade Ⅲ cartilage injuries according to MRI.
All patients were followed up 5.1-7.8 years, with an average of 5.5 years. There were 2 cases of numbness of lower extremity, 3 cases of slight exudation of incision, 2 cases of articular movement bounce, 5 cases of mild joint swelling and pain after exercise. At last follow-up, Lachman tests were negative in 18 cases and positive in 3 cases; anterior drawer tests were negative in 19 cases and positive in 2 cases; pivot shift tests were negative in all cases. Lysholm score was 84.5±16.5 and IKDC score was 85.25±4.60, which were significantly higher than those before operation ( <0.01). The flexion and extension of the affected knee joint were (128±13) and (3±7)°, respectively, which were smaller than those of the healthy knee joint [(133±15), (0±5)°] ( <0.01). The results of KT-1000 test showed that when knee flexion was 30 and 90°, tibial anterior displacement of affected side [(2.35±1.20), (1.60±1.15) mm] were not significantly different from those of healthy side [(1.20±1.10), (1.10±1.03) mm] ( >0.01). MRI showed that the ACL graft was in normal position and meniscus survived well. Cartilage injuries were gradeⅠ-Ⅱ in 18 cases and grade Ⅲ in 3 cases.
For patients with severe meniscus injury and ACL rupture, ACL reconstruction combined with meniscus allograft transplantation can restore the stability of the joint, recover the meniscus function which is conducive to the protection of articular cartilage and obtain satisfactory mid-term effectiveness.
总结关节镜下前交叉韧带（ACL）重建联合半月板同种异体移植的中期疗效。
回顾性分析2007年2月至2014年12月期间21例行关节镜下ACL重建及半月板同种异体移植且随访超过5年的患者的临床资料。其中男性12例，女性9例，年龄18～45岁，平均23.5岁。受伤原因：运动扭伤15例，摔伤4例，交通事故伤2例。受伤至手术时间2～36个月，平均12个月。其中15例曾行半月板切除术，平均间隔时间1.6年（范围3个月至6.5年）。所有患者均为初次ACL重建。术前前抽屉试验、Lachman试验及轴移试验均为阳性。Lysholm评分43.6±10.2。国际膝关节文献委员会（IKDC）评分60.50±14.06。21例患者中，根据MRI检查，10例为Ⅰ-Ⅱ级软骨损伤，11例为Ⅲ级软骨损伤。
所有患者随访5.1～7.8年，平均5.5年。出现下肢麻木2例，切口少量渗液3例，关节活动弹跳2例，运动后轻度关节肿胀疼痛5例。末次随访时，Lachman试验18例阴性，3例阳性；前抽屉试验19例阴性，2例阳性；轴移试验均为阴性。Lysholm评分84.5±16.5，IKDC评分85.25±4.60，均显著高于术前（<0.01）。患侧膝关节屈伸角度分别为（128±13）°和（3±7）°，小于健侧膝关节[（133±15）°，（0±5）°]（<0.01）。KT-1000试验结果显示，屈膝30°和90°时，患侧胫骨前移[（2.35±1.20），（1.60±1.15）mm]与健侧[（1.20±1.10），（1.10±1.03）mm]差异无统计学意义（>0.01）。MRI显示ACL移植物位置正常，半月板存活良好。软骨损伤18例为Ⅰ-Ⅱ级，3例为Ⅲ级。
对于半月板严重损伤合并ACL断裂的患者，ACL重建联合半月板同种异体移植可恢复关节稳定性，恢复半月板功能，有利于保护关节软骨，获得满意的中期疗效。
