全层腓骨长肌腱自体移植用于多韧带损伤和翻修病例的前交叉韧带重建：疗效及供区并发症
Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity.
作者信息
Goyal Tarun, Paul Souvik, Choudhury Arghya Kundu, Sethy Siddharth S
机构信息
Department of Orthopedics, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, 151001, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
出版信息
Eur J Orthop Surg Traumatol. 2023 Jan;33(1):21-27. doi: 10.1007/s00590-021-03145-3. Epub 2021 Oct 26.
PURPOSE
Peroneus longus tendon (PLT) autograft has been successfully used for isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction cases. Being a powerful evertor and flexor of great toe, there might be associated ankle morbidity with this autograft option. However, there are only a few studies exploring whether the ankle morbidity is significant or not. This study aims to assess the functional outcomes, donor site morbidity, and ankle strength after harvesting ipsilateral peroneus longus autograft for ACL reconstruction in revision ACL and multi-ligament injury cases.
METHODS
This was a prospective case series. All of the patients were evaluated by clinical examination for knee for laxity, ankle joint stability, and using visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, and Lysholm score, preoperatively and postoperatively at two-year follow-up. Morbidity of donor ankle was assessed using American Orthopedic Foot and Ankle Society (AOFAS) score, bilateral evertors, and first ray plantarflexion strength measurement using an isometer (Innovative Design Orthopedics) at two-year follow-up.
RESULTS
Ipsilateral PLT graft was used in ten patients of revision ACL reconstruction and 27 patients of the multi-ligament knee injury. The mean length of PLT harvested (cm) was 26.2 (standard deviation 2.6, range 22-31), and mean diameter of the doubled graft (mm) was 7.9 (standard deviation 0.68, range 7.5-8.5). There was a significant improvement in VAS score for pain, Lysholm, and IKDC scores (p = < 0.001) at two -year follow-up. There were no cases of graft failure, superficial, or deep infection. Ankle dorsiflexion(p = 0.32), ankle plantarflexion (p = 0.19), eversion strength(p = 0.6), first ray plantarflexion strength(p = 0.52), and AOFAS score(p = 0.29) were found to be comparable to the normal side in all patients.
CONCLUSIONS
Peroneus longus autograft can be considered as a potential autograft option for ACL reconstruction in multi-ligament knee injuries and revision ACL reconstruction. No significant donor site morbidity was noted at follow-up.
LEVEL OF EVIDENCE
Level IV.
目的
腓骨长肌腱（PLT）自体移植已成功用于单纯前交叉韧带（ACL）或后交叉韧带（PCL）重建病例。作为强大的足趾外翻肌和屈肌，这种自体移植方式可能会伴发踝关节病变。然而，仅有少数研究探讨踝关节病变是否显著。本研究旨在评估在翻修ACL和多韧带损伤病例中采用同侧腓骨长肌自体移植进行ACL重建后的功能结果、供区病变及踝关节力量。
方法
这是一个前瞻性病例系列研究。所有患者均在术前及术后两年随访时接受临床检查，评估膝关节松弛度、踝关节稳定性，并使用视觉模拟量表（VAS）评估疼痛程度、国际膝关节文献委员会（IKDC）评分和Lysholm评分。在两年随访时，使用美国矫形足踝协会（AOFAS）评分、双侧外翻肌及使用等距测力仪（Innovative Design Orthopedics）测量第一跖骨跖屈力量来评估供体踝关节的病变情况。
结果
10例翻修ACL重建患者和27例多韧带膝关节损伤患者采用了同侧PLT移植。采集的PLT平均长度（cm）为26.2（标准差2.6，范围22 - 31），双股移植的平均直径（mm）为7.9（标准差0.68，范围7.5 - 8.5）。在两年随访时，疼痛VAS评分、Lysholm评分和IKDC评分有显著改善（p = <0.001）。没有移植失败、浅表或深部感染病例。发现所有患者的踝关节背屈（p = 0.32）、踝关节跖屈（p = 0.19）、外翻力量（p = 0.6）、第一跖骨跖屈力量（p = 0.52）和AOFAS评分（p = 0.29）与正常侧相当。
结论
腓骨长肌自体移植可被视为多韧带膝关节损伤和翻修ACL重建中ACL重建的一种潜在自体移植选择。随访时未发现明显的供区病变。
证据水平
IV级。
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