Saragaglia D, Leroy J M, Tourne Y, Picard F, Abu al Zahab M
Service de Chirurgie Orthopédique et de Traumatologie du Sport, C.H.U de Grenoble-Hôpital Sud.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(3):230-8.
This is a retrospective study of 173 chronic laxities of the knee operated on between May 1985 and December 1988 using the Mac Intosh procedure, reinforced by the Kennedy L.A.D. Follow-up was between 4-8 years and the same surgeon operated on all the knees.
171 patients were operated on (113 men and 58 women) aged between 15-49 years (average age 26.5 years). The vast majority were sportsmen both at competition level (51 cases) and at recreational level (119 cases). The average time-span between accident and intervention was 15 months (1-240 months). In the pre-operative assessment, 80 cases (46.2 per cent) were found to have a grade II Lachman test and 91 cases (52.6 per cent), a grade III Lachman test; a positive pivot shift was found in more than 95 per cent of cases. There were lesions of the medial meniscus in 101 cases (58.4 per cent), of the lateral meniscus in 94 cases (54.4 per cent) and there was no meniscal lesion in only 41 cases (23.8 per cent). Finally there were 22 chondral lesions of the medial femoral condyle (12.7 per cent) and 7 of the lateral condyle (4.1 per cent).
These were based on 159 cases (14 lost to follow-up before the third post-operative month), but only 107 (61.8 per cent) were reviewed by one of us (i.e. not the original surgeon). Tolerance of the L.A.D. was excellent. There was no sign of synovitis or joint effusion persisting beyond 1 year. Furthermore, there were no serious complications (no sepsis, only 4 cases (2.3 per cent) of joint stiffness, 2 cases of reflex sympathetic dystrophy and 5 cases of sural phlebitis (2.9 per cent). Moreover, the few minor complications that arose resolved with the appropriate treatment. Anatomical results, evaluated using. Lachmans test (maximum manual Lachman measured with the Bercovy Laximeter) showed 24 cases (22.4 per cent) with zero differential residual laxity, 54 cases (50.5 per cent) with a differential laxity of between 0-2 mm; 20 cases (18.7 per cent) with a laxity of between 2-4 mm and in 9 cases (8.4 per cent) a laxity of greater than 4 mm. Functional results, using the Arpège C.L.A.S. system showed good results in 83 per cent (score > and unsatisfactory results in 17 per cent of cases. The long time-span between intervention and subsequent review with the C.L.A.S. system should be taken into account. However, the proportion of competitive sportsmen to recreational sportsmen was practically identical when comparing pre-traumatic figures (C = 29.5 per cent, R = 68.8 per cent) to figures at the time of follow-up (C = 21 per cent, R = 69.5 per cent). Radiological results (A.P. and Schuss films) showed 63 knees (58.9%) with no signs of either medial or lateral, preliminary or full-blown, femoro-tibial osteo-arthritis.
With an average follow-up of > 5 years (4-8 years), it is possible to say that ligamentoplasty of the anterior cruciate ligament using the Mac Intosh procedure reinforced with the Kennedy L.A.D. is not causative of any iatrogenic problems. The anatomical results were totally satisfactory (almost normal) in 72.9 per cent of cases; the radiological results showed ""normal'' knees in 58.9 per cent of cases and functional results were identical to results obtained using many other techniques.
这是一项对1985年5月至1988年12月间采用Mac Intosh手术并辅以Kennedy L.A.D.进行治疗的173例膝关节慢性松弛病例的回顾性研究。随访时间为4至8年，且所有膝关节手术均由同一位外科医生完成。
171例患者接受了手术（113名男性和58名女性），年龄在15至49岁之间（平均年龄26.5岁）。绝大多数患者无论是在竞技水平（51例）还是在娱乐水平（119例）都是运动员。事故与干预之间的平均时间跨度为15个月（1至240个月）。在术前评估中，发现80例（46.2%）Lachman试验为II级，91例（52.6%）为III级Lachman试验；超过95%的病例出现阳性轴移试验。内侧半月板损伤101例（58.4%），外侧半月板损伤94例（54.4%），仅41例（23.8%）无半月板损伤。最后，内侧股骨髁有22处软骨损伤（12.7%），外侧髁有7处软骨损伤（4.1%）。
基于159例病例（14例在术后第三个月前失访），但只有107例（61.8%）由我们其中一人进行了复查（即不是最初的外科医生）。Kennedy L.A.D.的耐受性极佳。术后1年以上没有滑膜炎或关节积液持续存在的迹象。此外，没有严重并发症（无败血症，仅4例（2.3%）关节僵硬，2例反射性交感神经营养不良，5例腓肠静脉炎（2.9%）。而且，出现的少数轻微并发症经适当治疗后得到缓解。使用Lachman试验（用Bercovy松弛计测量最大手动Lachman试验）评估的解剖学结果显示，24例（22.4%）差异残余松弛度为零，54例（50.5%）差异松弛度在0至2毫米之间；20例（18.7%）松弛度在2至4毫米之间，9例（8.4%）松弛度大于4毫米。使用Arpège C.L.A.S.系统评估的功能结果显示，83%的病例结果良好（评分> ，17%的病例结果不满意。应考虑干预与随后使用C.L.A.S.系统复查之间的长时间跨度。然而，将创伤前数据（竞技运动员占29.5%，娱乐运动员占68.8%）与随访时的数据（竞技运动员占21%，娱乐运动员占69.5%）进行比较时，竞技运动员与娱乐运动员的比例基本相同。放射学结果（前后位和侧位片）显示63个膝关节（58.9%）没有内侧或外侧、早期或完全性股骨 - 胫骨骨关节炎的迹象。
平均随访时间> 5年（4至8年），可以说采用Mac Intosh手术并辅以Kennedy L.A.D.进行前交叉韧带韧带成形术不会引起任何医源性问题。72.9%的病例解剖学结果完全令人满意（几乎正常）；放射学结果显示58.9%的膝关节“正常”，功能结果与使用许多其他技术获得的结果相同。
