A prospectively randomized double-blind study on the effect of initial graft tension on knee stability after anterior cruciate ligament reconstruction
A prospectively randomized double-blind study on the effect of initial graft tension on knee stability after anterior cruciate ligament reconstruction
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DOI：
10.1177/0363546504265924
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发表时间：
2004-12-01
影响因子：
4.8
通讯作者：
McHugh, MR
中科院分区：
文献类型：
--
作者：
Nicholas, SJ;D'Amato, MJ;McHugh, MR
背景：对于前交叉韧带移植物应施加的张力大小，以最好地促进移植物合并并重建正常的膝关节力学，目前尚未达成共识。假设：初始移植物张力的差异会影响术后膝关节的稳定性。研究设计：前瞻性、随机、双盲临床试验。方法：对 49 名接受骨-髌腱-骨自体移植物重建前交叉韧带重建的患者进行随机分组。分为高张力组（n = 27）和低张力组（n = 22）。移植物设置为 90 N 或 45 N。在手术前以及术后 1 周和平均 20 个月时进行胫骨前位移和膝关节活动范围的关节测量（KT-1000 关节计手动最大值）。收集膝关节结果评分。术前、术后进行比较，末次随访时还进行单腿跳动试验。结果：前交叉韧带重建后，低张力组患者胫骨前位移明显更大（P < .05）。术后1周，高张力组和低张力组胫骨前位移的左右差异分别为1.1 +/- 1.7 mm和2.4 +/- 2.4 mm，随访时分别为2.2 +/- 1.6 mm和3.0 +/- 2.2 mm。 5 名患者出现胫骨前移异常（左右差异>5 mm），且全部属于低张力组（P < .05）。手术后膝关节结果评分有所改善 (P < .01)，低张力组和高张力组的结果相似。各组之间的跳跃测试缺陷没有差异。结论：初始移植物张力影响膝关节稳定性的恢复。 45 N 的移植物张力不足以恢复膝关节稳定性。
Background: No consensus exists on the amount of tension that should be applied to anterior cruciate ligament grafts to best facilitate graft incorporation and re-create normal knee mechanics.Hypothesis: Differences in initial graft tension will affect postoperative knee stability.Study Design: Prospective, randomized, double-blind clinical trial.Methods: Forty-nine patients undergoing bone-patellar tendon-bone autograft anterior cruciate ligament reconstruction by a single surgeon were randomized into high-tension (n = 27) and low-tension (n = 22) groups. Grafts were set at 90 N or 45 N. Arthrometric measurements (KT-1000 arthrometer manual maximum) of anterior tibial displacement and knee range of motion were made before surgery and at 1 week and an average of 20 months after surgery. Knee outcome scores were collected. before and after surgery, and a single-leg hop test was also performed at final follow-up.Results: After anterior cruciate ligament reconstruction, anterior tibial displacement was significantly greater in the patients in the low-tension group (P < .05). The side-to-side difference in anterior tibial displacement in the high-tension and low-tension groups was 1.1 +/- 1.7 mm versus 2.4 +/- 2.4 mm 1 week after surgery and 2.2 +/- 1.6 mm versus 3.0 +/- 2.2 mm at follow-up. Five patients had abnormal anterior tibial displacement (>5 mm side-to-side difference), and all were in the low-tension group (P < .05). Knee outcome scores improved with surgery (P < .01), with similar results for low-tension and high-tension groups. Hop test deficits were not different between groups.Conclusions: Initial graft tension affects the restoration of knee stability. A graft tension of 45 N was not sufficient for restoring knee stability.