Mishra Debashish, Sondur Suhas, Mohanty Anwesit, Mohanty Swatantra, Gulia Ankit, Das Shakti Prasad
Department of Orthopaedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneshwar, Odisha 751024 India.
Indian J Orthop. 2024 Oct 23;59(1):54-61. doi: 10.1007/s43465-024-01283-4. eCollection 2025 Jan.
Anatomic single-bundle ACL reconstruction (ACLR) produces good results when the graft and tunnel are positioned in the anatomic footprint on the femoral and tibial insertion sites in a more oblique orientation. The of the knee and its biomechanical role in controlling rotational laxity, internal rotation, and pivot shift has led to adding adjunctive procedures like extra-articular augmentation and lateral extra-articular tenodesis (LET) to decrease rotational laxity. We prospectively analyzed young adults with rotational instability and generalized laxity undergoing an arthroscopic single bundle ACLR with an additional LET procedure.
42 patients, aged between 20 and 50, undergoing all-inside ACLR augmented with concomitant lateral extra-articular tenodesis between November 2020 and October 2021 were included. All patients were followed up for one year and functional assessment comprised of the International Knee Documentation Committee [IKDC] score, visual analogue score [VAS], and Lysholm Knee Scoring Scale at 6 months and 1 year. Return to activity was assessed using the Tegner Activity Score.
The Lysholm score, IKDC score, and VAS showed significant improvements at 6 months after ACLR + LET ( < 0.0001) and further improved significantly at 1 year. The patients had a significant decline in the Tegner Activity Scale at 6 months but returned to the near pre-injury level (5.98 ± 0.924) at 1 year (5.67 ± 0.816) which was insignificant ( = 0.1067). Three patients sustained mild complications. 93% were satisfied with the surgery, 66% returned to sports and no patient underwent re-operation.
Combination of LET with ACLR produces good functional outcomes, high rates of return to sports activities, and no graft failure in young patients at high risk of failure.
当移植物和骨隧道以更倾斜的方向置于股骨和胫骨止点的解剖足迹内时，解剖单束前交叉韧带重建术（ACLR）可产生良好效果。膝关节的 及其在控制旋转松弛、内旋和轴移方面的生物力学作用，促使人们增加诸如关节外增强和外侧关节外腱固定术（LET）等辅助手术，以减少旋转松弛。我们对患有旋转不稳定和全身松弛的年轻成年人进行了前瞻性分析，这些患者接受了关节镜下单束ACLR并附加LET手术。
纳入2020年11月至2021年10月期间接受全内置ACLR并同时进行外侧关节外腱固定术的42例年龄在20至50岁之间的患者。所有患者均接受了一年的随访，功能评估包括在6个月和1年时的国际膝关节文献委员会（IKDC）评分、视觉模拟评分（VAS）和Lysholm膝关节评分量表。使用Tegner活动评分评估恢复活动情况。
ACLR + LET术后6个月时，Lysholm评分、IKDC评分和VAS均有显著改善（<0.0001），并在1年时进一步显著改善。患者在6个月时Tegner活动量表评分显著下降，但在1年时恢复到接近伤前水平（5.98±0.924）（术前为5.67±0.816），差异无统计学意义（=0.1067）。3例患者出现轻度并发症。93%的患者对手术满意，66%的患者恢复运动，无患者接受再次手术。
LET与ACLR联合应用可产生良好的功能结果、较高的恢复运动活动率，且在高失败风险的年轻患者中无移植物失败情况。
