Revision anterior cruciate ligament surgery: Experience from Miami
Revision anterior cruciate ligament surgery: Experience from Miami
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DOI：
10.1097/00003086-199604000-00010
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发表时间：
1996-04-01
影响因子：
4.2
通讯作者：
TjinATsoi, EW
中科院分区：
文献类型：
--
作者：
Uribe, JW;Hechtman, KS;TjinATsoi, EW
前交叉韧带重建失败的定义为复发性病理性疼痛越来越常见。本报告介绍了54例前交叉韧带关节内重建术矫正持续性不稳定失败的患者的结果，这些患者随后接受了前交叉韧带翻修手术。翻修前，通过临床检查、KT-1000关节测量仪、X线片、Lysholm膝关节评分、Tegner活动量表和主观问卷对患者进行评估。在翻修手术后平均32个月时比较结果。从首次手术到翻修的平均时间为16个月。61%的病例使用自体髌腱移植物，其中30%取自对侧膝关节。35%采用新鲜冷冻髌腱，4%采用自体腘绳肌腱。翻修成功地客观改善了所有患者的稳定性，平均KT-000为2.8 mm。与平均KT-1000分别为2.2和3.3的同种异体组织相比，自体组织移植物提供了更大的客观稳定性。然而，在功能上，两组之间的结果没有显著差异。发现对侧髌腱的收获没有长期不良影响。主观上，根据关节软骨退变的程度，结果明显更差。只有54%的患者恢复到前交叉韧带损伤前的活动水平。掌握各种前交叉韧带重建技术将有助于翻修手术，尤其是避免既存隧道和内固定器械。正确的移植物放置和解决二次限制是成功翻修手术的关键。
Failed anterior cruciate ligament reconstitution as defined by recurrent patholaxity is increasingly commonplace. This report presents the findings of 54 patients wire had unsuccessful intraarticular anterior cruciate Ligament reconstruction to correct persistent instability and who subsequently underwent revision anterior cruciate ligament surgery. Before revision, patients were evaluated by clinical examination, KT-1000 arthrometer, radiographs, Lysholm knee score, Tegner activity scale, and subjective questionnaire. The results were compared at a mean of 32 months following revision surgery. There was an average of 16 months from index procedure to the time of revision. Autogenous patellar tendon grafts were used in 61% of the cases with 30% of these harvested from the contralateral knee. Fresh frozen patellar tendon was used in 35% and autogenous hamstring tendons in 4%. Revision was successful in objectively improving stability in all patients with an average KT-000 of 2.8 mm. Autogenous tissue grafts provided greater objective stability when compared with allograft tissue with average KT-1000 of 2.2 and 3.3, respectively. Functionally, however, there was no significant difference in outcome between the 2 groups. Harvesting of the contralateral patellar tendon was found to have no adverse long term effect. Subjectively, the results were significantly worse depending on the degree of articular cartilage degeneration. Only 54% of patients returned to their preanterior cruciate ligament injury activity level. Competence in various anterior cruciate Ligament reconstruction techniques will facilitate revision surgery especially in avoiding preexisting tunnels and hardware. Correct graft placement and addressing the secondary restraints are critical to successful revision surgery.