Double-bundle versus single-bundle anterior cruciate ligament reconstruction:: a prospective, randomize clinical study
Double-bundle versus single-bundle anterior cruciate ligament reconstruction:: a prospective, randomize clinical study
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DOI：
10.1007/s00167-006-0254-z
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发表时间：
2007-05-01
影响因子：
3.8
通讯作者：
Jarvela, Timo
中科院分区：
文献类型：
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作者：
Jarvela, Timo
解剖学观察和生物力学研究表明，前交叉韧带（ACL）主要由前内侧束（AM）和后外侧束（PL）组成。传统的单束ACL重建技术主要关注AM束的恢复，而对PL束的关注有限。本前瞻性随机临床研究的目的是比较使用双束或单束技术和生物可吸收界面螺钉固定进行ACL重建的结局，以及使用两种技术进行类似康复的结局。65例患者随机分为两组，采用腘绳肌腱和生物可吸收螺钉（Hexalon，Inion Company，Tampere，Finland）固定进行双束（n = 35）或单束（n = 30）ACL重建。评估方法包括临床检查、KT-1000关节测量仪测量、放射学评估以及国际膝关节文献委员会和Lysholm膝关节评分。术前研究组间无差异。平均随访14个月（范围12-20个月），双束组有30例患者，单束组有29例患者（91%）。在随访时，旋转稳定性，通过轴移试验评价，双束组明显优于单束组。然而，在膝关节前稳定性方面，两组之间没有显著差异。双束组中没有患者发生移植失败，而单束组中有4例患者发生移植失败。此外，随访时两组的膝关节评分相同，随访时所有结果均显著优于术前。
Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of two distinct bundles, the anteromedial (AM) bundle and posterolateral (PL) bundle. Conventional single-bundle ACL reconstruction techniques have focused on the restoration of the AM bundle while giving limited attention to the PL bundle. The purpose of this prospective, randomized clinical study is to compare the outcomes of ACL reconstruction when using either double-bundle or single-bundle technique and bioabsorbable interference screw fixation, and similar rehabilitation with both techniques. Sixty-five patients were randomized into either double-bundle (n = 35) or single-bundle (n = 30) ACL reconstruction with hamstring tendons and bioabsorbable screw (Hexalon, Inion Company, Tampere, Finland) fixation in both groups. The evaluation methods were clinical examination, KT-1000 arthrometer measurements, radiographic evaluation, as well as International Knee Documentation Committee and Lysholm knee scores. There were no differences between the study groups preoperatively. For an average of 14 months of follow-up (range 12-20 months), 30 patients of the double-bundle group and 29 patients of the single-bundle group were available (91%). At the follow-up, the rotational stability, as evaluated by pivot shift test, was significantly better in the double-bundle group than in the single-bundle group. However, in anterior stability of the knee, there was no significant difference between the groups. None of the patients in the double-bundle group had graft failure, while four patients in the single-bundle group had. In addition, knee scores were equal at the follow-up, and all the results were significantly better at the follow-up than preoperatively, in both groups.