关节镜下半腱肌/股薄肌腱移植重建前交叉韧带

Arthroscopic reconstruction of anterior crucial ligament using semitendinosus-cracilis autograft

目的探讨膝关节镜下采用自体半腱肌/股薄肌腱移植重建前交叉韧带的方法和效果。方法回顾分析54例膝关节镜下应用自体双股半腱肌/股薄肌腱移植重建前交叉韧带的情况,随访2年以上纳入分析。采用Lysholm关节评分、国际膝关节文献编制委员会(IKDC)分级评估标准和KT-1000关节测量仪测定稳定性评价疗效。结果平均随访30.8个月,Lysholm关节评分由术前58分提高到术后95分,优良率96.3%。IKDC功能评价29例(53.7%)正常、24例(44.5%)基本正常、1例(1.8%)异常。KT-1000测定优38例(70.4%),良15例(27.8%),差1例(1.8%),平均移动度2.1mm。结论关节镜下自体双股半腱肌/股薄肌腱移植重建前交叉韧带方法可行,疗效确切。术后能早期康复锻炼,稳定性好,并发症少。

[Objective] To investigate the surgical technique of arthroscopic isometric anterior crucial ligament reconstruction using hamstring tendon autograft and evaluate its efficacy. [Methods] A retrospective analysis was done in 54 consecutive patients with a chronic ruptured anterior crucial ligament underwent arthroscopic reconstruction using an ipsilateral semitendinosus-gracilis autograft. Concurrent operative procedures were performed during the arthroscopic procedure included repair of a meniscal tear. The mean age of patients was 33.1 year old, with a minimum follow-up of 24 months. Tile patient satisfaction was assessed with the Lysholm knee score pre- and post-operatively and functional status was assessed with the International Knee Documentation Committee （IKDC） rating scale. A KT-1000 arthrometer was used for evaluating ACL ligament stability. [Results] Average follow-up was 30.8 months （range, 24 to 48 months）. The median Lysholm knee score was improved from 58 preoperatively to 95 postoperatively. Overall, 96.3% of patients had a good or excellent result. According to overall IKDC assessment, 29 （53.7%）, 24（44.5%） and 1（1.8%） cases had been graded A, B and C respectively. Average KT-1000 side-to-side laxity measurement was 2.1 ram. At 24 months after operation, all patients had excellent knee stability, a high rate of retum to sport or work and minimal radiological evidence of degenerative change. No complication of disrupt graft was found. [Conclusion] Arthroscopic anterior crucial ligament reconstruction using two-strand semitendinosus- gracilis autograft is a reasonable alterative to ACL reconstruction that has a high short- term stability rate, high patient satisfaction level, good postoperative function and a low postoperative complication rate. Early and systemic postoperative exercises are the key for successful rehabilitation.