Lobenhoffer P
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Zentralbl Chir. 1998;123(9):981-93.
ACL reconstruction with a patellar tendon autograft has reached a high grade of perfection. Surgery can be performed mini-open or arthroscopically, both techniques are presently equal in morbidity and results. The optimal insertion areas for the graft have been defined and can be controlled intra- and postoperatively by radiographs. The bone blocks of the graft allow for stable fixation and an aggressive functional rehabilitation program stressing active full extension of the joint. Disadvantages are a certain donor site morbidity and a rate of restrictions in range-of-motion. The management of arthrofibrosis should address the pathogenesis. Localized arthrofibrosis is caused by a mechanical conflict in the knee and removal of the mechanical block will usually solve the problem. Generalized arthrofibrosis is a complex process involving the entire joint and resulting in a wide-spread proliferative reaction of the connective tissue. The surgical management must be more complex involving open debridement and capsulotomies.
采用自体髌腱进行前交叉韧带重建已达到很高的完善程度。手术可采用小切口开放或关节镜技术进行，目前这两种技术在发病率和手术效果方面相当。已确定移植物的最佳植入区域，并且可以在术中及术后通过X线片进行控制。移植物的骨块可实现稳定固定，并可开展积极的功能康复计划，强调关节的主动完全伸展。缺点是供区存在一定的发病率以及活动范围受限率。关节纤维化的处理应针对其发病机制。局限性关节纤维化是由膝关节的机械性冲突引起的，去除机械性阻碍通常可解决问题。广泛性关节纤维化是一个复杂的过程，涉及整个关节，并导致结缔组织广泛的增殖反应。手术处理必须更加复杂，包括开放清创和关节囊切开术。
