Kartus J, Stener S, Lindahl S, Engström B, Eriksson B I, Karlsson J
Department of Orthopedics, Norra Alvsborgs Hospital, Trollhättan, Sweden.
Knee Surg Sports Traumatol Arthrosc. 1997;5(4):222-8. doi: 10.1007/s001670050054.
The objective of this study was to assess knee function after anterior cruciate ligament reconstruction focusing on residual donor-site problems. Ninety consecutive patients with chronic unilateral anterior cruciate ligament rupture were operated on by the same surgeon using patellar tendon autografts, the all-inside arthroscopic technique, and interference screw fixation. At the follow-up examination 24 (range 22-32) months after the index operation, the median total anterior-posterior KT-1000 side-to-side difference was 2.5 (-7 to 11) mm. The median Lysholm score was 86 (range 37-100) points and the median Tegner activity level was 6 (range 1-9). Using the IKDC evaluation system, 62 of 90 (69%) were classified as normal or nearly normal. The median one-leg-hop quotient was 93 (range 0-167)% of the uninjured leg. Of 90 patients, 44 (49%) had minor or no discomfort when asked to walk on their knees (kneewalkers) and 46 of 90 (51%) patients had severe problems or found it impossible to perform the test (non-kneewalkers). The 'kneewalkers' had a median loss of anterior knee sensitivity of 10 (range 0-120) cm2. The corresponding value for the 'non-kneewalkers' was 25 (range 0-200) cm2 (P = 0.0001). Palpatory donor-site tenderness was registered in 19 of 44 (43%) of the 'kneewalkers' and 37 of 46 (80%) of the 'non-kneewalkers' (P < 0.001). Full hyperextension was not regained by 9 of 44 (20%) of the 'kneewalkers' and 19 of 46 (41%) of the 'non-kneewalkers' (P < 0.05). Additional surgery during the follow-up period was required by 6 of 44 (14%) of the 'kneewalkers' and 19 of 46 (41%) of the 'non-kneewalkers' (P < 0.01). Magnetic resonance imaging focusing on the donor site was performed on 31 randomly selected patients and revealed no difference between the 'kneewalkers' and the 'non-kneewalkers' in terms of patellar tendon width, thickness, length, and residual donor-site gap size. The kneewalking test was found to be a functional and reliable test for detecting donor-site morbidity. It appears that donor-site morbidity was related to problems requiring additional surgery during the follow-up period, such as extension deficit and pain near the metal implant on the tibial side, as well as the loss of anterior knee sensitivity. It appears to be important to attempt to preserve the sensitivity in the operated area during surgery and to regain full hyperextension in the postoperative period to minimize donor-site morbidity.
本研究的目的是评估前交叉韧带重建术后的膝关节功能，重点关注供区残留问题。90例连续的慢性单侧前交叉韧带断裂患者由同一位外科医生采用髌腱自体移植、全关节镜技术和挤压螺钉固定进行手术。在初次手术后24（范围22 - 32）个月的随访检查中，前后方向KT - 1000两侧差值的中位数为2.5（-7至11）mm。Lysholm评分的中位数为86（范围37 - 100）分，Tegner活动水平的中位数为6（范围1 - 9）。使用IKDC评估系统，90例中有62例（69%）被分类为正常或接近正常。单腿跳商的中位数为健侧腿的93（范围0 - 167）%。90例患者中，44例（49%）在被要求用膝盖行走（屈膝行走者）时仅有轻微不适或无不适，90例患者中有46例（51%）存在严重问题或无法完成该测试（非屈膝行走者）。“屈膝行走者”膝关节前部感觉丧失面积的中位数为10（范围0 - 120）cm²。“非屈膝行走者”的相应值为25（范围0 - 200）cm²（P = 0.0001）。44例“屈膝行走者”中有19例（43%）可触及供区压痛，46例“非屈膝行走者”中有37例（80%）可触及供区压痛（P < 0.001）。44例“屈膝行走者”中有9例（20%）未能恢复完全伸直，46例“非屈膝行走者”中有19例（41%）未能恢复完全伸直（P < 0.05）。随访期间，44例“屈膝行走者”中有6例（14%）需要再次手术，46例“非屈膝行走者”中有19例（41%）需要再次手术（P < 0.01）。对31例随机选择的患者进行了聚焦于供区的磁共振成像检查，结果显示“屈膝行走者”和“非屈膝行走者”在髌腱宽度、厚度、长度和供区残留间隙大小方面无差异。屈膝行走测试被发现是检测供区并发症的一项功能可靠的测试。似乎供区并发症与随访期间需要再次手术的问题有关，如伸直受限和胫骨侧金属植入物附近疼痛，以及膝关节前部感觉丧失。在手术过程中试图保留手术区域的感觉并在术后恢复完全伸直以尽量减少供区并发症似乎很重要。
