Breitfuss H, Fröhlich R, Povacz P, Resch H, Wicker A
Department of Traumatology, Salzburg General Hospital, Austria.
Knee Surg Sports Traumatol Arthrosc. 1996;3(4):194-8. doi: 10.1007/BF01466615.
Retrospective clinical and radiographic evaluation was performed on 41 patients seen at the Salzburg General Hospital Department of Traumatology on average 2 years following ACL reconstruction. In 26 patients (61%) clinical examination revealed pain trigger points over the donor site of the midthird patellar tendon and in the patellofemoral joint. Functional pain during kneeling activities was observed in 19 patients (46%). Objective measurement of the length of the patellar tendon in bilateral radiographs demonstrated exactly equal patellar tendon length in both knees in 11 patients (27%). The radiographs showed tendon shortening following harvesting of the midthird patellar tendon by 1-3 mm in 7 patients (17%), by 4-6 mm in 16 (39%), and by 6-9 mm in 7 (17%). Average length change in the patellar tendon on the donor side was -3 mm, representing a patellar tendon shortening of 9.8%. On the basis of the OAK score, however, good and very good results were recorded in 33 patients (80%). On the whole, these good overall results were compromised only be patellar tendon defect morbidity. In addition to the local scarring problems at the donor site, shortening of the patellar tendon was observed with changes to patella position and interference with the mechanics of the patellofemoral joint. Tendon shortening can be explained on the basis of cicatricial contraction in the process of autorepair to the tendon defect. The problems affecting the patellofemoral joint are inherent in the therapy and must be treated as a negative factor. In the case of patients whose work requires mainly a kneeling position and those who make significant functional demands of the extension system of the knee, a critical assessment is required of the use of the midthird patellar tendon for anterior cruciate ligament reconstruction.
对萨尔茨堡总医院创伤科平均在ACL重建术后2年就诊的41例患者进行了回顾性临床和影像学评估。26例患者（61%）临床检查发现髌腱中1/3供区和髌股关节有疼痛触发点。19例患者（46%）在跪姿活动时出现功能性疼痛。对双侧X线片上髌腱长度的客观测量显示，11例患者（27%）双膝髌腱长度完全相等。X线片显示，7例患者（17%）髌腱中1/3被采集后腱缩短1 - 3 mm，16例患者（39%）缩短4 - 6 mm，7例患者（17%）缩短6 - 9 mm。供体侧髌腱平均长度变化为-3 mm，相当于髌腱缩短9.8%。然而，根据OAK评分，33例患者（80%）取得了良好和非常好的结果。总体而言，这些良好的整体结果仅受到髌腱缺损发病率的影响。除了供体部位的局部瘢痕问题外，还观察到髌腱缩短，伴有髌骨位置改变和髌股关节力学干扰。腱缩短可基于腱缺损自身修复过程中的瘢痕收缩来解释。影响髌股关节的问题是该治疗所固有的，必须将其视为一个负面因素。对于工作主要需要跪姿的患者以及对膝关节伸展系统功能要求较高的患者，需要对使用髌腱中1/3进行前交叉韧带重建进行严格评估。
