Lerat J L, Moyen B, Garin C, Mandrino A, Besse J L, Brunet-Guedj E
Service de Chirurgie Orthopédique et de Médecine du Sport, Hôpital E Herriot, Lyon.
Rev Chir Orthop Reparatrice Appar Mot. 1993;79(5):365-74.
Fifty-one knees were reviewed out of 53 which had been operated on (between 1981 and 1991) for instability due to a long-standing rupture of the anterior cruciate ligament (A.C.L.), associated with medial arthritis related to a varus deformity. They had undergone a reconstruction of the cruciate ligament using the patellar tendon (5 cases had received an artificial ligament) and a high tibial osteotomy. In 80 per cent of cases this was an opening osteotomy with interposition of a heterologous bone graft, and in 39 cases it was a closing osteotomy. The average age was 37 +/- 6 years. The oldest patient was 58 years old. 80 per cent of cases were men and 88 per cent of the patients practised sport on a regular basis at the time of the accident. The average delay before surgery was 9.5 years. Almost all the patients has already undergone a medial meniscectomy and there were deep cartilaginous lesions and the bone was exposed in 50 per cent of cases. 28 knees were reexamined after a follow-up of over 4 years. Based on the ARPEGE score the results on pain and stability were good. Return to sport has been possible for 43 per cent of patients. Pivot shift, which was constant before surgery (grade 2 or 3), disappeared in 20 cases and was estimated at grade 1 in 8 cases (of which 6 had suffered a rupture of the graft). For the 20 cases in which the reconstruction of the A.C.L. had held, the average anterior radiological subluxation was 4.3 +/- 3.2 mm (from 2 to 14 mm) and the average gain after surgery was 6.7 +/- 3.7 mm (from 2.5 to 18 mm). The femoro-tibial angle went from an average of 6 degrees of varus to 3 degrees of valgus. The opening osteotomy was more precise for correction in the frontal plane. A large valgus (over 3 degrees) was not desirable and a hypercorrection was occasionally difficult to accept by relatively young patients who are likely to take up sport again. The osteotomy often involuntarily modified the normal posterior tibial plateau slope (especially closing osteotomy). A backwards increase of the tibial plateau slope is a factor which increases the anterior subluxation of the femur on the tibia. This is confirmed before and after surgery. It seems preferable to decrease the tibial slope during the osteotomy in order to protect the A.C.L. reconstruction.(ABSTRACT TRUNCATED AT 400 WORDS)
在1981年至1991年间，因前交叉韧带（A.C.L.）长期断裂导致不稳定并伴有与内翻畸形相关的内侧关节炎而接受手术的53例患者中，对51例患者的膝关节进行了评估。他们接受了使用髌腱重建交叉韧带的手术（5例接受了人工韧带）以及高位胫骨截骨术。80%的病例采用了开放截骨术并植入异体骨移植，39例采用了闭合截骨术。平均年龄为37±6岁，年龄最大的患者为58岁。80%的病例为男性，88%的患者在事故发生时经常进行体育活动。手术前的平均延迟时间为9.5年。几乎所有患者都已经接受了内侧半月板切除术，50%的病例存在深层软骨损伤且骨质暴露。在随访超过4年后，对28例膝关节进行了复查。根据ARPEGE评分，疼痛和稳定性方面的结果良好。43%的患者能够恢复运动。术前持续存在的轴移（2级或3级）在20例中消失，8例估计为1级（其中6例移植体发生了断裂）。对于A.C.L.重建成功的20例患者，术前平均前向放射学半脱位为4.3±3.2毫米（范围为2至14毫米），术后平均改善为6.7±3.7毫米（范围为2.5至18毫米）。股骨 - 胫骨角从平均6度内翻变为3度外翻。开放截骨术在额状面的矫正更为精确。过大的外翻（超过3度）不理想，对于可能再次从事体育活动的相对年轻患者，偶尔难以接受过度矫正。截骨术常常会不自觉地改变正常的胫骨后平台坡度（尤其是闭合截骨术）。胫骨平台坡度向后增加是导致股骨在胫骨上向前半脱位增加的一个因素。这在手术前后均得到证实。为了保护A.C.L.重建，在截骨术中似乎最好减小胫骨坡度。（摘要截取自400字）
