关节镜下前交叉韧带重建后内侧和外侧半月板同期移植术

Both the medial and lateral meniscal aHograft transplantation following the anterior cruciate ligament reconstruction by arthroscopic surgical technique

目的探讨全关节镜下前交叉韧带重建后内侧和外侧半月板同期移植的微创手术技术。方法2008年8月对1例实施膝关节双束双通道前交叉韧带重建、内侧和外侧半月板切除的患者，在关节镜下实施内侧和外侧半月板同期移植微创手术。内侧半月板移植采用前后角骨栓固定方法，外侧半月板移植采用前后角骨桥固定方法。术后结果采用VAS疼痛评分、Lysholm评分和国际膝关节评分委员会（IKDC）分级评价。关节稳定性检查包括Lachman试验、抽屉试验和轴移试验。结果术后随访26个月，患者膝关节屈曲、伸直和负重行走功能正常。VAS膝关节疼痛评分较术前降低2分，Lysholm评分较术前升高20分。IKDC分级由术前C级上升到B级。膝关节稳定性检查基本正常。术后1年MRI检查显示，重建前交叉韧带连续性完整，内侧和外侧移植异体半月板外形均较好，内侧半月板后角和外侧半月板前角有轻微萎缩。术后18个月关节镜复检观察到，外侧和内侧移植半月板均愈合良好，形态完整，但前角表面均有轻度磨损现象。结论对膝前交叉韧带损伤和内、外侧半月板切除的患者，在前交叉韧带重建术后同期实施内侧和外侧半月板移植术可以尽量恢复膝关节的稳定性和力学平衡，对年轻患者是可供选择的治疗方式。术中建议采用同一供体的内侧和外侧异体半月板，制作各骨道时须注意其方向以避免骨道相互交通。

Objective To discuss the minimal invasive arthroscopic surgery technique and clinical results of both the medial and lateral meniseal transplantation following the anterior cruciate ligament reconstruction with double bundles and bone tunnels. Methods In August 2008 a minimal invasive surgery of both the medial and lateral meniscal allograft transplantation following anterior crueiate ligament reconstruction was preformed for 1 case with both the medial and lateral menicectomy by arthroseopie surgery. The method of two bone plugs attached on tibial plateau was employed for medial meniscal allograft transplantation and the technique the bridge in slot for lateral meniseal allograft transplantation. The VAS, Lysholm score and IKDC rating were recorded before and after operation. The stability of knee was assessed by Lachman test, drawer sign and pivot shift test. Results The patient was followed up 26 month after the operations. The degrees of knee flexion, extension and function of walk were normal. The Lachman test, drawer sign and pivot shift test were nearly normal. The VAS after operation was 2 points lower than that before operation. The Lysholm score post-operation was 20 points higher than pre-operation. The IKDC became B degree in late following-up from C degree before the operation. MRI revealed anterior cruciate ligament graft was continuous and the meniscal allograft was normal shape on year 1 after the operation. The posterior horn of medial meniscal ailograft and anterior corner of lateral meniscal allograft showed slightly shrunk. The second-look arthroscopy showed that the healing occurring between meniscal allograft and the capsule and meniseal allograft was normal shape on month 18 after the operation. The anterior horn of medial and lateral meniscus was slightly worn. Conclusions Both the media] and lateral meniscal transplantationfollowing the anterior cruciate ligament reconstruction in appropriately selected patients with the medial and lateral meniscus-deficient knee may recover the knee mechanic balance and stability, which is a option of treatment for that young and activity patients. It is proposed that the medial and lateral meniscal grafts harvested from a single donator. Attention should be paid to the direction of the bone tunnels fixing the horns of the meniscus in order to avoid communication with the tunnels of anterior cruciate ligament reconstruction.