共用前交叉韧带骨道技术:关节镜下前交叉韧带重建中修复外侧半月板后根部损伤

Shared Anterior Cruciate Ligament Bone Tunnel Technique:Repair of Lateral Meniscus Posterior Root Tears With Anterior Cruciate Ligament Reconstruction Under Arthroscopy

目的探讨共用前交叉韧带(anterior cruciate ligament,ACL)骨道技术在关节镜下ACL重建中修复外侧半月板后根部(lateral meniscus posterior root,LMPR)损伤的临床疗效。方法2015年3月~2019年3月对32例ACL断裂合并LMPR损伤在关节镜下ACL重建中采用共用ACL骨道技术修复LMPR损伤。术前和末次随访对患者进行膝关节功能评估,MRI和二次关节镜探查评估共用ACL骨道技术的临床疗效。结果32例随访(20.5±5.1)月,Lysholm、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分从术前(46.1±9.4)、(44.4±9.8)分提高到末次随访(91.4±4.0)、(91.9±4.1)分(t=-36.668,P=0.000;t=-38.348,P=0.000);KT-1000侧侧差值从术前(9.1±2.2)mm下降到末次随访(2.9±1.1)mm(t=29.223,P=0.000);胫骨前移距离从术前(6.4±1.6)mm下降到末次随访(2.4±0.9)mm(t=31.550,P=0.000);外侧半月板外突从术前(3.6±1.2)mm下降到(1.2±0.6)mm(t=21.778,P=0.000);轴移试验等级下降明显(Z=-5.080,P=0.000);术前与末次随访膝关节软骨退变差异虽有显著性(Z=-2.236,P=0.025),但未见明显进展。32例末次随访MRI提示LMPR损伤完全愈合26例(81.3%);15例二次关节镜探查,LMPR损伤完全愈合11例(73.3%)。结论关节镜下ACL重建中共用ACL骨道技术修复LMPR损伤,能提高膝关节功能评分,改善膝关节稳定性,纠正胫骨前移和外侧半月板外突。

Objective To explore the clinical efficacy of the shared anterior cruciate ligament(ACL)bone tunnel technique in the repair of lateral meniscus posterior root(LMPR)injury with ACL reconstruction under arthroscopy.Methods From March 2015 to March 2019,we used shared ACL bone tunnel technique to repair LMPR injury with ACL reconstruction in 32 patients with ACL rupture concomitant LMPR injury.The patients were evaluated for knee function before operation and at the last follow-up.The MRI examination and secondary arthroscopic inspection were used to explore the clinical efficacy of the shared ACL bone tunnel technique.Results The 32 patients were followed up for(20.5±5.1)months.The Lysholm score and International Knee Documentation Committee(IKDC)score increased from(46.1±9.4)and(44.4±9.8)points before surgery to(91.4±4.0)and(91.9±4.1)points at the last follow-up,respectively(t=-36.668,P=0.000;t=-38.348,P=0.000);the KT-1000 side difference value decreased from(9.1±2.2)mm to(2.9±1.1)mm(t=29.223,P=0.000);the anterior tibia distance decreased from(6.4±1.6)mm to(2.4±0.9)mm(t=31.550,P=0.000);the lateral meniscus protrusion decreased from(3.6±1.2)mm to(1.2±0.6)mm(t=21.778,P=0.000).The grade of the axis shift test dropped significantly(Z=-5.080,P=0.000).Although there was significant difference in knee cartilage degeneration between preoperative and last follow-up(Z=-2.236,P=0.025),there was no significant progress.At the last follow-up the MRI showed that LMPR injury was completely healed in 26 cases(81.3%).There were 15 cases undergoing a secondary arthroscopic inspection,and 11 of them were completely healed(73.3%).Conclusion The shared ACL bone tunnel technique in the repair of LMPR injury with ACL reconstruction can improve the knee function score,improve the stability of knee joint,and correct the forward movement of tibia and the external process of lateral meniscus.