Revision Anterior Cruciate Ligament Reconstruction by Double-Bundle Technique Using Multi-Strand Semitendinosus Tendon
Revision Anterior Cruciate Ligament Reconstruction by Double-Bundle Technique Using Multi-Strand Semitendinosus Tendon
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DOI：
10.1016/j.arthro.2009.09.014
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发表时间：
2010-06-01
影响因子：
4.7
通讯作者：
Sekiya, Ichiro
中科院分区：
文献类型：
--
作者：
Muneta, Takeshi;Hara, Kenji;Sekiya, Ichiro
目的：本研究的目的是比较使用多股半腱肌腱双束（DB）技术进行前交叉韧带（ACL）翻修重建与使用相同技术进行初次重建的结果。研究方法：该研究纳入了21例在1995年至2006年期间采用半腱肌腱DB技术进行ACL翻修重建（平均随访，40个月）的患者，以及86例在2000年至2004年期间进行单侧初次DB ACL重建（平均随访，33个月）的患者。根据手术和未手术肢体之间的差异以及改良的国际膝关节文献委员会分级，比较两组的结局。对两组的总体和运动相关主观评分进行评价。结果如下：翻修组KT测量值（MEDmetric，San Diego，CA）平均为1.7 mm（SD，1.8 mm），初次组平均为1.5 mm（SD，1.6 mm）。两组之间的KT测量值无显著差异。Lachman试验在83%的翻修病例和87%的初次病例中呈阴性;前抽屉试验分别在83%和91%中呈阴性，并且移位试验分别在78%和90%中呈阴性。翻修组的正向移位试验有较高的趋势。翻修组的Lysholm评分和主观恢复评分显著较低。结论：半腱肌腱DB翻修手术提供的活动度和前部稳定性与初次DB手术后相当，并且恢复体育活动的情况也相当。然而，患者倾向于有积极的快速转移试验结果。翻修病例在膝关节状况恢复的总体评价方面也较差。翻修组的结局评分总体较低。证据等级：IV级，治疗病例系列。
Purpose: The purpose of the study was to compare the outcome of revision anterior cruciate ligament (ACL) reconstruction by the double-bundle (DB) technique using multi-strand semitendinosus tendon with that of primary reconstruction by use of the same technique. Methods: The study included 21 patients who underwent revision ACL reconstruction (mean follow-up, 40 months) with the semitendinosus tendon DB technique between 1995 and 2006 and 86 unilateral primary DB ACL reconstructions (mean follow-up, 33 months) between 2000 and 2004. The outcome of both groups was compared based on differences between operated and unoperated limbs and modified International Knee Documentation Committee grades. Both the overall and sports-related subjective scores were evaluated between the 2 groups. Results: The KT measurements (MEDmetric, San Diego, CA) averaged 1.7 mm (SD, 1.8 mm) in the revision group and 1.5 mm (SD, 1.6 mm) in the primary group. There was no significant difference in KT measurements between the 2 groups. The Lachman test was negative in 83% of revision cases and 87% of primary cases; the anterior drawer test was negative in 83% and 91%, respectively, and the pivot-shift test was negative in 78% and 90%, respectively. There was a tendency for a positive pivot-shift test in the revision group being higher. The Lysholm score and subjective recovery score were significantly lower in the revision group. Conclusions: The semitendinosus tendon DB revision procedure provided range of motion and anterior stability comparable to those after primary DB surgery and a comparable return to athletic activities. However, the patients tended to have positive pivot-shift test results. The revision cases were also inferior in terms of the general evaluation of recovery of knee condition. The outcome scores were lower overall in the revision group. Level of Evidence: Level IV, therapeutic case series.