Steadman Philippon Research Institute, Vail, CO, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2676-2683. doi: 10.1007/s00167-021-06479-x. Epub 2021 Feb 22.
Compare side-to-side differences for knee kinematics between anatomic single-bundle (SB) and anatomic double-bundle (DB) ACLR during downhill running at 6 and 24 months post ACLR using high-accuracy dynamic stereo X-ray imaging. It was hypothesized that anatomic DB ACLR would better restore tibio-femoral kinematics compared to SB ACLR, based on comparison to the contralateral, uninjured knee.
Active individuals between 14 and 50 years of age that presented within 12 months of injury were eligible to participate. Individuals with prior injury or surgery of either knee, greater than a grade 1 concomitant knee ligament injury, or ACL insertion sites less than 14 mm or greater than 18 mm were excluded. Subjects were randomized to undergo SB or DB ACLR with a 10 mm-wide quadriceps tendon autograft harvested with a patellar bone block and were followed for 24 months. Dynamic knee function was assessed during treadmill downhill running using a dynamic stereo X-ray tracking system at 6 and 24 months after surgery. Three-dimensional tibio-femoral kinematics were calculated and compared between limbs (ACLR and uninjured contralateral) at each time point.
Fifty-seven subjects were randomized (29 DB) and 2-year follow-up was attained from 51 (89.5%). No significant differences were found between SB and DB anatomic ACLR for any of the primary kinematic variables.
Contrary to the study hypothesis, double-bundle reconstruction did not show superior kinematic outcomes compared to the single-bundle ACLR. While neither procedure fully restored normal knee kinematics, both anatomic reconstructions were similarly effective for restoring near-normal dynamic knee function. The findings of this study indicate both SB and DB techniques can be used for patients with average size ACL insertion sites.
Level I.
使用高精度动态立体 X 射线成像，比较 ACLR 后 6 个月和 24 个月时解剖学单束 (SB) 和解剖学双束 (DB) ACLR 在 downhill 跑步中的膝关节运动学的侧别差异。假设基于与未受伤的对侧膝关节相比，解剖学 DB ACLR 会比 SB ACLR 更好地恢复胫股关节运动学。
符合条件的参与者为 14 至 50 岁的活跃个体，受伤后 12 个月内就诊。排除双侧膝关节既往损伤或手术史、大于 1 级伴发膝关节韧带损伤、ACL 插入点小于 14mm 或大于 18mm 的个体。受试者随机接受 SB 或 DB ACLR，使用 10mm 宽的股四头肌肌腱自体移植物和髌骨骨块进行，随访 24 个月。术后 6 个月和 24 个月，使用动态立体 X 射线跟踪系统在跑步机下坡跑步中评估膝关节动态功能。在每个时间点计算并比较四肢（ACLR 和未受伤的对侧）的三维胫股关节运动学。
57 名受试者被随机分配（29 名 DB），51 名（89.5%）获得 2 年随访。在任何主要运动学变量方面，SB 和 DB 解剖学 ACLR 之间均无显著差异。
与研究假设相反，双束重建并未显示出比单束 ACLR 更好的运动学结果。虽然两种手术均未完全恢复正常的膝关节运动学，但两种解剖重建方法对于恢复接近正常的动态膝关节功能同样有效。本研究的结果表明，SB 和 DB 技术都可以用于 ACL 插入点大小适中的患者。
I 级。
