Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France.
Laboratoire INSERM-UNISTRA UMR 1260, 11 rue Humann, 67085, Strasbourg, France.
Eur J Orthop Surg Traumatol. 2020 Aug;30(6):1033-1038. doi: 10.1007/s00590-020-02661-y. Epub 2020 Mar 27.
Results of iterative ACL reconstructions are lower than after primary reconstructions. Our aim was to report the results of a retrospective series of revision using pedicled quadruple hamstring autograft. The hypothesis was that the results were satisfactory and comparable to the literature.
The study period was from January 2012 to December 2014. Fourteen patients (average age 26) were included. A fascia lata graft was used 12 times for primary reconstruction. Trauma was the cause of failure 12 times. The time interval between primary reconstruction and revision was 6.2 years. Preoperative scores used were LYSHOLM, TEGNER and IKDC. Sagittal stability was measured using the KT-1000 device. X-rays and MRI were performed to confirm the diagnosis, look for preoperative osteoarthritis and evaluate the position of the bony tunnels (Bernard and Hertel). Bone tunnels were in a proper position 14 times.
At 45-month follow-up, improvement of objective IKDC score was significant (85.7% A/B, p < 0.0002) as well as subjective IKDC score (85.5, p < 0.0004). A significant improvement was established for the LYSHOLM score (91.8, p = 0.001) using the Wilcoxon test. The average LYSHOLM score was 92% (p > 0.5), and the average TEGNER score was 5.5 (p = 0.003). The Lachman test found a hard stop in all patients. The pivot shift test was negative for 78.5% of the cases. The laxity measurement found 12 cases with less than 3 mm. One persistent distal hypoesthesia at 2-year follow-up was observed.
The hypothesis was confirmed. This series differs by the cause of failure, which was essentially traumatic, and the initial predominance of a fascia lata graft. These results remain to be confirmed.
Retrospective case series, level IV.
膝关节前交叉韧带（ACL）翻修术后的疗效不如初次重建。本研究旨在报告使用带蒂四股腘绳肌腱重建移植物进行膝关节 ACL 翻修的回顾性系列结果。我们假设结果是令人满意的，并且与文献中的结果相当。
研究时间为 2012 年 1 月至 2014 年 12 月。共纳入 14 例患者（平均年龄 26 岁）。12 次为初次重建时使用阔筋膜移植物，12 次为初次重建失败。初次重建和翻修之间的时间间隔为 6.2 年。术前使用 LYSHOLM、TEGNER 和 IKDC 评分。使用 KT-1000 设备测量矢状面稳定性。行 X 线和 MRI 检查以确认诊断，寻找术前骨关节炎并评估骨隧道位置（Bernard 和 Hertel）。14 次骨隧道位置均适当。
随访 45 个月时，客观 IKDC 评分（85.7% A/B，p<0.0002）和主观 IKDC 评分（85.5，p<0.0004）显著改善。使用 Wilcoxon 检验，LYSHOLM 评分也有显著改善（91.8，p=0.001）。平均 LYSHOLM 评分为 92%（p>0.5），平均 TEGNER 评分为 5.5（p=0.003）。Lachman 试验发现所有患者均有硬性终止。78.5%的病例髌腱试验为阴性。松弛度测量发现 12 例患者的松弛度小于 3mm。1 例患者在术后 2 年随访时仍存在持续的远端感觉减退。
本研究假设得到证实。与初次重建失败的原因主要为创伤性不同，本研究中阔筋膜移植物的初始使用率较高。这些结果仍需进一步证实。
回顾性病例系列研究，IV 级。
