腘绳肌移植物联合关节外肌腱固定术治疗高度轴移ACL损伤

Lateral Extra⁃articular Tenodesis Combined with Anterior Cruciate Ligament Reconstruction U⁃sing Hamstring Autograft in Patients with High⁃grade Pivot Shift Test

目的评估使用自体腘绳肌移植物重建前交叉韧带(Anterior cruciate ligament,ACL)联合关节外肌腱固定术(Lateral extra⁃articular tenodesis,LET)治疗高度轴移患者的早期临床疗效及移植物信号情况。方法对2018年7月至2020年4月连续收治的高度轴移ACL损伤病例进行回顾性研究。在77例术前麻醉状态下存在高度轴移的ACL病例中,32例为LET联合ACL重建术(纳入LET组),45例未行LET术(纳入单纯ACL重建组)。比较两组术后至少2年时的主观功能评分(Kujala评分和Lysholm评分)、膝关节稳定性评估(KT⁃1000测试和轴移试验)结果和移植物的核磁共振(Magnetic resonance imaging,MRI)信号。移植物信号分为Ⅰ级(好)、Ⅱ级(中等)和Ⅲ级(差)。结果LET组的随访时间为(24.2±2.2)个月,小于常规重建组的(25.9±1.9)个月,差异有统计学意义(t=3.664,P<0.001)。末次随访时,LET组的移植物信号为I级27例、2级5例、3级0例,优于单纯ACL重建组的I级24例、2级16例、3级5例,差异有统计学意义(W=484,P=0.003)。两组主观功能评分和膝关节稳定性评估的差异有统计学意义(P<0.001)。结论LET联合ACL重建术在治疗高度轴移患者时,相比单纯ACL重建术能够在术后2年时改善ACL移植物的信号、功能评分和膝关节稳定性。

Objective To evaluate the short⁃term clinical outcomes and graft signal of anterior cruciate ligament(ACL)reconstruction combined with lateral extra⁃articular tenodesis(LET)using hamstring autograft in patients with high⁃grade pivot shift test.Methods Consecutive patients with high⁃grade pivot shift test of ACL injuries were retrospectively reviewed from July 2018 to April 2020.Among 77 high⁃grade pivot shift of ACL injury cases,32 were performed with LET combined with ACL reconstruction(LET group)and the other 45 were performed isolated ACL reconstruction(isolated ACL reconstruc⁃tion group).Functional scores(Kujala scores and Lysholm score),knee stability measurements(KT⁃1000 and pivot⁃shift test)as well as graft signal on magnetic resonance imaging(MRI)were compared between the two groups at a minimum 2⁃year follow⁃up.The graft signal was classified as gradeⅠ(good),Ⅱ(moderate),andⅢ(poor).Results The follow⁃up time of the LET group was 24.2±2.2 months,which was less than that of the 25.9±1.9 months in the isolated reconstruc⁃tion group,and the difference was statistically significant(t=3.664,P<0.001).At the last follow⁃up,the graft signals in the LET group were 27 cases of class I,5 cases of level 2,and 0 cases of level 3,which were better than 24 cases of class I,16 cases of level 2,and 5 cases of level 3 of the isolated reconstruction group,and the difference was statistically significant between the two groups(W=484,P=0.003).The difference between the subjective functional scores and the assessment of knee stability between the two groups were statistically significant(P<0.001).Conclusion LET combined ACL recon⁃struction have better ACL graft signaling,functional score,and knee stability at 2 years follow⁃up compared with isolated ACL reconstruction alone in patients with high⁃grade pivot shift test.