Lerat J L, Besse J L, Vincent P, Bontemps S, Limouzy F, Moyen B, Brunet-Guedj E
Service de Chirurgie Orthopédique et de Médecine du Sport, Hôpital E. Herriot, Lyon.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(5):404-9.
The aim of this study was to evaluate clinical and radiological sequelae following removal of part of the patellar tendon for A.C.L. reconstruction.
A consecutive and homogenous series of 100 patients operated for chronic anterior instability (66 men, 34 women; age 16 to 55 years, average: 28.5 years) was studied. The procedure involved a free patellar tendon graft harvested from the mid third of the tendon and including its bony attachments, and in particular a long strip from the patella and a strip 10 centimeters long from the rectus femoris tendon for extra-articular reconstruction. Tendon graft sites were closed. Patellae and tibial tunnels were filled with bone debris from the drilling, and the pre-patellar fascia was closed. The mean follow-up period was 35 months. pain and radiological alterations (with pre-operative X-rays as reference) were studied, particularly for: calcifications, patellar height changes using the Insall, Blackburne and Caton methods, increase in patella tip length, femoro-patellar joint alteration.
Calcification were found in: quadriceps tendon: 24 per cent of cases (always painless), Pre-patellar: 16 per cent of cases (usually less than 5 mm), Superior patellar tendon: 47 per cent of cases (only 2 cases being painful, no unaffected tendons were painful), Inferior patellar tendon: 7 per cent of cases (1 in the mid), Tibia tunnel: 26 per cent of cases. No cases required surgical removal. Patellar tip length did not increased significantly. Patellar tendon length decreased by 1.37 mm. Patellar height measured by the Insall, Blackburne and Caton methods was not significantly affected. The femoro-patellar joint was normal in 95 per cent of cases. There were five cases of remodelling, one being painful.
Graft harvested from the extension system for A.C.L. reconstruction frequently resulted in radiological sequelae but were usually asymptomatic. In most cases these calcifications concerned the superior patellar tendon, quadricipital tendon and pre-patellar zone. Patella height was not affected.
本研究旨在评估在为重建前交叉韧带而切除部分髌腱后出现的临床和放射学后遗症。
对连续的100例因慢性前交叉韧带不稳定而接受手术的患者（66例男性，34例女性；年龄16至55岁，平均28.5岁）进行了研究。手术过程包括取自髌腱中三分之一并带有其骨附着点的游离髌腱移植，特别是取自髌骨的一条长条和取自股直肌肌腱的一条10厘米长的条带用于关节外重建。腱移植部位进行了缝合。髌骨和胫骨隧道用钻孔产生的骨碎片填充，髌前筋膜进行了缝合。平均随访期为35个月。研究了疼痛和放射学改变（以术前X线片作为对照），特别是针对：钙化、使用Insall、Blackburne和Caton方法测量的髌骨高度变化、髌骨尖长度增加、髌股关节改变。
发现钙化情况如下：股四头肌肌腱：24%的病例（均无疼痛），髌前：16%的病例（通常小于5毫米），髌上肌腱：47%的病例（仅2例有疼痛，未受累肌腱无疼痛），髌下肌腱：7%的病例（1例在中部），胫骨隧道：26%的病例。无一例需要手术切除。髌骨尖长度没有显著增加。髌腱长度减少了1.37毫米。用Insall、Blackburne和Caton方法测量的髌骨高度没有受到显著影响。95%的病例髌股关节正常。有5例发生重塑，1例有疼痛。
从伸展系统获取用于重建前交叉韧带的移植物经常导致放射学后遗症，但通常无症状。在大多数情况下，这些钙化涉及髌上肌腱、股四头肌肌腱和髌前区域。髌骨高度未受影响。
