关节镜下双股半腱及股薄肌腱经双胫骨隧道解剖重建膝前交叉韧带

Arthroscopic double tibial tunnel anterior cruciate ligament anatomical reconstruction using double-looped semitendinosis and gracilis tendon

目的:介绍在关节镜下应用自体双股半腱和股薄肌腱(DLSTG)经双胫骨隧道解剖重建膝前交叉韧带(ACL)的手术方法及术后随访结果。方法:在关节镜下对15例ACL断裂的患者行双胫骨隧道解剖重建。移植体股、胫骨端均采用近ACL解剖止点之Press fit技术固定。结果:全部患者于术后6～8周恢复了正常的关节活动和行走步态。手术12～16周后恢复了低风险体育运动。术后1年,2名患者的Lachman试验I度阳性;15名患者的IKDC评分为正常或接近正常;Tegner评分显示12名患者已恢复伤前运动水平;X线片示全部患者股骨、胫骨隧道无扩大。结论:关节镜下利用自体DLSTG及Press fit固定技术施行双胫骨隧道的ACL解剖重建在技术上可行,并有利于伤膝功能的快速恢复。

Objective:To describe a new technique for arthroscopic double tibial tunnel anterior cruciate ligament(ACL) anatomical reconstruction using double-looped semitendinosis and gracilis tendon(DLSTG) autograft. The outcome of follow-up was evaluated. Method:Fifteen cases of ACL ruptures were reconstructed anatomically with double tibial tunnel under arthroscopy. The femoral and tibial fixations of the autograft are close to the points of the native ACL insertions by the technique of press-fit.Result:All patients regained normal range of motion of the knee and gait at 6～8 weeks postoperation, and returned to the low risk sports at 12～16 weeks. One year after operation, lachman test was one degree positive in two cases; The IKDC analysis revealed normal or near normal knees in 15 patients;The Tegner score revealed that 12 patients had regained their preinjury activity level;No patient had a significant femoral or tibial tunnels enlargement on follow-up radiographs.Conclusion:Arthroscopic double tibial tunnel ACL reconstruction using DLSTG and the technique of Press-fit is practicable,and the rapid restoration of the injured knee function can be expected.