Trauma Center Graz, Teaching Hospital of the Medical University Graz, Graz, Austria.
Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
Sportverletz Sportschaden. 2021 Jun;35(2):103-114. doi: 10.1055/a-1281-8627. Epub 2020 Nov 30.
Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee.
Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases.
Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were "normal" in 15 and 14 patients, "nearly normal" in 11 and 7 patients, and "abnormal" in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test.
Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.
前交叉韧带（ACL）损伤可导致功能降低、半月板损伤和早期关节退变。使用内置式支具技术保留撕裂的 ACL 可能会重新建立正常的膝关节运动学，避免因肌腱采集而导致供区发病率，并可能维持膝关节的本体感觉。
本研究于 2015 年 12 月至 2016 年 10 月期间招募了 50 名受试者。纳入两组单侧 ACL 破裂的个体：一组采用保留受伤 ACL 的手术治疗（内置式支具技术；IB），另一组采用腘绳肌腱移植物重建 ACL（全内技术；AI）。使用主观自我评估评分：德国版 IKDC 主观膝关节评分表（国际膝关节文献委员会）、德国版 WOMAC（西安大略和麦克马斯特大学关节炎指数）、SF-36（简短形式）、德国版 KOOS（膝关节骨关节炎结局评分）和 Lysholm 和 Gillquist 的改良 Lysholm 评分。使用 KT-1000 关节测径仪（KT-1000 膝关节韧带关节测径仪，MEDmetric 公司，圣地亚哥，加利福尼亚州，美国）评估胫骨前移位。所有病例均进行磁共振评估。
23 名受试者（46%）为男性，平均年龄为 34.7 岁。IB 和 AI 组中，15 名和 14 名患者的客观 IKDC 评分分别为“正常”和“接近正常”，11 名和 7 名患者为“异常”。KT-1000 评估显示，在最大手动测试中，IB 和 AI 组分别有 11 名（44%）和 6 名（28.6%）患者的侧间差值超过 3mm。在术后 MRI 中，IB 和 AI 组分别有 20 名（74%）和 22 名（96%）患者 ACL 完整。在手动最大测试中，IB 组的胫骨前移位明显高于 AI 组。
使用内置式支具原发性修复技术保留原 ACL 可在短期内获得与使用腘绳肌腱自体移植物重建 ACL 相当的结果。在研究期间，观察到与临床相关的限制，如较高的病理性松弛发生率，患者更易发生枢轴移位现象。
