Tajima Takuya, Yamaguchi Nami, Morita Yudai, Yokoe Takuji, Nagasawa Makoto, Ota Tomomi, Kawagoe Shuichi, Nakamura Yoshihiro, Chosa Etsuo
Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
J Knee Surg. 2023 Aug;36(10):1095-1101. doi: 10.1055/s-0042-1749603. Epub 2022 Jun 10.
This study was conducted to present remnant-preserving anterior cruciate ligament (ACL) augmentation as a useful option for partial ACL injury in multiligament knee injury (MLKI) cases, which may also contribute to conserving graft resources. The present study involved patients diagnosed with MLKI at our institute from Spring 2006 to February 2021. A total of 71 MLKI cases were provided surgery due to knee instability and disability. For every patient, an arthroscopic diagnostic was performed to ensure that ACL tear and a remnant were present. When the ACL remnant was classified into group 2, 3, or 4 of Nakamae's classification, remnant-preserved single bundle ACL augmentation was performed. Graft selection and the combination of injured ligaments were evaluated. The side-to-side difference under an anterior tibial load of 134 N with an arthrometer and the leg symmetry index at 60 degrees/s were measured. The present procedure was performed for five cases (male/female: 4/1, mean age: 33.6 years). The mean follow-up period was 26.4 months. The combination of torn ligaments was as follows: 3 cases of ACL + medial collateral ligament, one case of ACL + posterior cruciate ligament, and one case of ACL + posterolateral corner. An ACL augmentation graft was performed using an ipsilateral gracilis tendon in 2 cases, a contralateral full semitendinosus tendon in 2 cases, and the ipsilateral distal 1/2 of the semitendinosus tendon in 1 case. The mean side-to-side difference was 1.07 ± 0.4 mm. The mean leg symmetry index was 82.6 ± 12.2% in knee extension and 96.3 ± 9.9% in knee flexion. Although the present study was a small case series, the remnant-preserved single-bundle ACL augmentation for MLKI surgery provided good clinical outcome and conserved the graft resource. Even in the MLKI case, this technique is one of the useful surgical options. The level of evidence of this study is level IV (case series).
本研究旨在提出保留残端的前交叉韧带（ACL）增强术，作为多韧带损伤（MLKI）病例中部分ACL损伤的一种有效选择，这也可能有助于节约移植物资源。本研究纳入了2006年春季至2021年2月期间在我院被诊断为MLKI的患者。共有71例MLKI病例因膝关节不稳定和功能障碍接受了手术。对每位患者进行关节镜诊断，以确保存在ACL撕裂和残端。当ACL残端被分类为中前分类的2、3或4组时，进行保留残端的单束ACL增强术。评估移植物选择和损伤韧带的组合。使用关节测量仪在134 N的前向胫骨负荷下测量两侧差异，并在60°/s时测量腿对称指数。本手术共进行了5例（男/女：4/1，平均年龄：33.6岁）。平均随访期为26.4个月。撕裂韧带的组合如下：3例为ACL + 内侧副韧带，1例为ACL + 后交叉韧带，1例为ACL + 后外侧角。2例使用同侧股薄肌腱进行ACL增强移植物手术，2例使用对侧全股薄肌腱，1例使用同侧半腱肌远端1/2。平均两侧差异为1.07±0.4 mm。膝关节伸展时平均腿对称指数为82.6±12.2%，膝关节屈曲时为96.3±9.9%。尽管本研究是一个小病例系列，但MLKI手术中保留残端的单束ACL增强术提供了良好的临床效果，并节约了移植物资源。即使在MLKI病例中，该技术也是一种有效的手术选择。本研究的证据水平为IV级（病例系列）。
