Wasilewski S A, Covall D J, Cohen S
Sun Valley Sports Medicine, ID 83353.
Am J Sports Med. 1993 May-Jun;21(3):338-42. doi: 10.1177/036354659302100302.
This study was undertaken to determine the optimal time after injury for arthroscopically assisted anterior cruciate ligament reconstruction using a double semitendinosus graft. We analyzed 87 patients. Time from injury to surgery was established as acute, subacute, or chronic; the three groups were matched. Meniscal damage and treatment were categorized. Chondral lesions were graded, postoperative parameters of motion, strength recovery, and stability were tabulated at 3, 6, 12, and 18 months. Complications were compared. Six percent of the patients with chronic knee injuries had two normal menisci at surgery, compared with 29% of the acute and subacute groups. Reparable tears were found in 37.8% of the knees. Chondral lesions were found in the tibiofemoral joint in 17% of acute, 7% of subacute, and 44% of the chronic knees. Postoperative motion recovery was significantly less at all time intervals for the acute group. Quadriceps strength recovery was slower in the acute knees. Stability was similar in all groups. Arthrofibrosis was found in 22% of acute, 0 subacute, and 12.5% of the chronic knees. Patellofemoral pain was noted in 17% of the acute, 0 of the subacute, and 9.3% of the chronic knees. This study showed that surgery done within 6 months of injury does not jeopardize the knee. Recovery after acute anterior cruciate ligament reconstruction is significantly slower than after subacute or chronic reconstruction.
本研究旨在确定使用双股半腱肌移植物进行关节镜辅助下前交叉韧带重建的最佳损伤后时间。我们分析了87例患者。从损伤到手术的时间分为急性、亚急性或慢性；三组进行了匹配。半月板损伤及治疗进行了分类。软骨损伤进行了分级，在术后3个月、6个月、12个月和18个月时列出了活动度、力量恢复和稳定性的参数。对并发症进行了比较。慢性膝关节损伤患者中有6%在手术时半月板正常，而急性和亚急性组为29%。在37.8%的膝关节中发现了可修复的撕裂。在急性膝关节中，17%的胫股关节发现软骨损伤，亚急性膝关节中为7%，慢性膝关节中为44%。急性组在所有时间间隔的术后活动度恢复均明显较差。急性膝关节的股四头肌力量恢复较慢。所有组的稳定性相似。在急性膝关节中发现22%有关节纤维化，亚急性膝关节中为0，慢性膝关节中为12.5%。在急性膝关节中，17%出现髌股关节疼痛，亚急性膝关节中为0，慢性膝关节中为9.3%。本研究表明，在损伤后6个月内进行手术不会对膝关节造成损害。急性前交叉韧带重建后的恢复明显慢于亚急性或慢性重建后的恢复。
