Kdolsky R K, Gibbons D F, Kwasny O, Schabus R, Plenk H
Department of Traumatology, University of Vienna Medical School, Austria.
J Orthop Res. 1997 Jan;15(1):1-10. doi: 10.1002/jor.1100150102.
Long-term clinical results and short-term arthroscopic and microscopic findings from two augmented reconstruction procedures for the ruptured anterior cruciate ligament are reported. The braided polypropylene ligament augmentation device (Kennedy model) was used with temporary double-end fixation in 279 patients to augment the attachment of the anterior cruciate ligament after acute proximal rupture and in 315 patients to augment a bone-tendon-bone autograft, mainly after chronic instability. Check arthroscopy was performed and the metal fixation hardware was removed after a mean of 11 months. Of the 569 patients evaluated, 101 partial or total breakages of the ligament augmentation device were found. Together with nine breakages detected late in the follow-up period, 110 (19.3%) failures were found. Most of these failures were accompanied by effusion that was immediately alleviated when the failed device was removed. No generalized synovitis was visible. Scanning electron microscopic analysis of 24 retrieved failed ligament augmentation devices showed fatigue to be the principal failure mode, together with local abrasion at the fracture. Synovial biopsies were taken during arthroscopy in 84 patients with and without ligament augmentation device-failure who had given informed consent, and histological evaluation revealed that in 21 patients, chronic but no acute synovial inflammation was found, and wear particles could be identified in foreign body cells in 17. Statistically, the presence of chronic synovitis was predicted neither by wear particles and foreign body cells nor by abrasion or fatigue failure of the ligament augmentation device. Irrespective of the failures, for which ligament augmentation device removal is recommended, in the final Orthopaedische Arbeitsgemeinschaft Knie evaluation (after a mean of 6.2 years), excellent and good clinical results were found in 83.6% of all 594 patients.
报告了两种用于前交叉韧带断裂的增强重建手术的长期临床结果以及短期关节镜和显微镜检查结果。编织聚丙烯韧带增强装置（肯尼迪模型）用于279例急性近端断裂后增强前交叉韧带附着的患者，采用临时双端固定，还用于315例主要是慢性不稳定后增强骨-肌腱-骨自体移植物的患者。平均11个月后进行检查性关节镜检查并取出金属固定硬件。在评估的569例患者中，发现101例韧带增强装置出现部分或完全断裂。连同随访后期检测到的9例断裂，共发现110例（19.3%）失败病例。这些失败病例大多伴有积液，取出失败装置后积液立即缓解。未见全身性滑膜炎。对24个取出的失败韧带增强装置进行扫描电子显微镜分析显示，疲劳是主要的失败模式，同时骨折处存在局部磨损。在关节镜检查期间，对84例有或没有韧带增强装置失败且已签署知情同意书的患者进行了滑膜活检，组织学评估显示，21例患者存在慢性而非急性滑膜炎，17例患者的异物细胞中可识别出磨损颗粒。从统计学上看，慢性滑膜炎的存在既不能通过磨损颗粒和异物细胞预测，也不能通过韧带增强装置的磨损或疲劳失效预测。尽管存在建议取出韧带增强装置的失败病例，但在最终的德国膝关节外科协会评估（平均6.2年后）中，594例患者中有83.6%获得了优良的临床结果。
