Prospective Randomized Clinical Evaluation of Conventional Single-Bundle, Anatomic Single-Bundle, and Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction 281 Cases With 3-to 5-Year Follow-up
Prospective Randomized Clinical Evaluation of Conventional Single-Bundle, Anatomic Single-Bundle, and Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction 281 Cases With 3-to 5-Year Follow-up
复制标题
DOI：
10.1177/0363546511426416
复制
发表时间：
2012-03-01
影响因子：
4.8
通讯作者：
Fu, Freddie H.
中科院分区：
文献类型：
--
作者：
Hussein, Mohsen;van Eck, Carola F.;Fu, Freddie H.
背景资料：三种不同的前交叉韧带（ACL）重建技术-传统（经胫骨）单束（CSB）、解剖单束（ASB）和解剖双束（ADB）-已被描述。目的：为了确定是否需要双束重建来恢复旋转稳定性或是否解剖放置单束可以产生类似的结果。证据等级，1。方法：2005年12月至2007年12月，320例患者前瞻性随机分为3组：ADB、ASB和CSB重建。平均随访51.15个月（范围：39-63个月）。最终随访时，有281例患者可用。在所有组中，股侧采用腘绳肌肌腱悬吊固定，胫骨侧采用生物可吸收界面螺钉固定。由一名独立的设盲观察员使用Lysholm评分和主观国际膝关节文献委员会（IKDC）表格评价结局。KT-1000关节测量仪用于评估前后稳定性，并使用位移测试来确定旋转stability.Results：解剖单束重建比CSB重建的前后和旋转稳定性更好（ASB组胫骨前平移的平均侧-侧差异为1.6 mm，CSB组为2.0 mm; P = 0.002）。负轴移为66.7% vs 41.7%（P = .003）。在其他参数中，组间差异无统计学意义。在前后位和旋转稳定性方面，ADB组的结果也上级ASB组（ADB组胫骨前平移的平均侧-侧差异为1.2 mm，ASB组为1.6 mm; P = .002）。负轴移分别为93.1%和66.7%（P <0.001），活动度也有显著差异（P = 0.005）。CSB、ASB和ADB组的Lysholm评分分别为90.9、91.8和93.0。只有当我们比较ADB和CSB时，差异才有统计学意义（P = 0.025）。CSB、ASB和ADB组的主观IKDC评分分别为90.2、90.6和92.1。结论：解剖双束重建ACL明显上级传统单束重建，优于解剖单束重建。解剖单束重建优于传统单束重建，具有上级的优越性。然而，这些差异很小，可能不具有临床相关性。
Background: Three different techniques of anterior cruciate ligament (ACL) reconstruction-conventional (transtibial) single bundle (CSB), anatomic single bundle (ASB), and anatomic double bundle (ADB)-have been described.Purpose: To determine if double-bundle reconstruction is needed to restore rotational stability or if anatomic placement of a single bundle can yield similar results.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: From December 2005 to December 2007, 320 patients were prospectively randomized into 3 groups: ADB, ASB, and CSB reconstruction. The average follow-up was 51.15 months (range, 39-63 months). At the final follow-up, 281 patients were available. In all groups, hamstring tendons were used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score and subjective International Knee Documentation Committee (IKDC) form. The KT-1000 arthrometer was used to evaluate anteroposterior stability, and the pivot-shift test was used to determine rotational stability.Results: Anatomic single-bundle reconstruction resulted in better anteroposterior and rotational stability than CSB reconstruction (average side-to-side difference for anterior tibial translation was 1.6 mm in the ASB group vs 2.0 mm in the CSB group; P = .002). Negative pivot shift was 66.7% vs 41.7% (P = .003). In other parameters, the differences between groups were not statistically significant. The results of the ADB group were also superior to the ASB group for anteroposterior and rotational stability (average side-to-side difference for anterior tibial translation was 1.2 mm in the ADB group vs 1.6 mm in the ASB group; P = .002). Negative pivot shift was 93.1% vs 66.7%, respectively (P < .001), and range of motion was also significantly different (P = .005). The Lysholm score was 90.9, 91.8, and 93.0 in the CSB, ASB, and ADB groups, respectively. The difference was significant only when we compared ADB and CSB (P = .025). Subjective IKDC scores were 90.2, 90.6, and 92.1 in the CSB, ASB, and ADB groups, respectively. The difference was not significant.Conclusion: Anatomic double-bundle ACL reconstruction is significantly superior to conventional single-bundle ACL reconstruction and better than anatomic single-bundle reconstruction. Anatomic single-bundle reconstruction was superior to conventional single-bundle reconstruction. However, these differences are small and may not be clinically relevant.