Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity
Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity
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DOI：
10.1007/s00167-010-1247-5
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发表时间：
2011-03-01
影响因子：
3.8
通讯作者：
Jacobs, C. A.
中科院分区：
文献类型：
--
作者：
Branch, T. P.;Siebold, R.;Jacobs, C. A.
比较接受单束（SB）或双束（DB）前交叉韧带（ACL）重建治疗的患者体内关节松弛的客观测量值。64名年龄、身高、体重匹配且接受过单侧SB或DB腿筋重建的患者参与了本研究。使用KT 1000关节测量仪记录双侧胫骨前平移（ATT），并使用机器人测试系统评估旋转特征的侧到侧差异。对每个重建进行评价，以确定其模拟正常膝关节前后位（AP）和旋转生物力学的程度。如果ATT和内旋（IR）分别在3 mm和3.5 A度内，则重建被定义为模仿正常膝关节。SB组ATT的侧-侧差异（2.2 +/- A 1.4 mm）显著高于DB组（1.1 +/- A 1.0 mm，P = 0.001）。虽然SB组（1.3A度）和DB组（1.1A度，P = 0.82）的相对IR侧侧差异无差异，但DB重建组的绝对IR差异显著较小（2.1A度vs. 4.7A度，P = 0.001）。与SB患者的34%相比，DB患者（81%，P = 0.0003）的ATT和IR与正常膝关节相似的百分比显著更高;然而，IKDC主观评分在两组之间没有差异。无论采用哪种技术，非手术膝关节旋转松弛度最大的患者IKDC评分明显更差。DB重建减少了ATT和IR的侧-侧差异。DB技术比SB技术更一致地再现了未受伤肢体的生物力学特征，而不会增加膝关节过度约束的风险。
To compare objective measures of in vivo joint laxity between patients treated with single-bundle (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstructions.Sixty-four patients matched by age, height, weight, and that had undergone unilateral SB or DB hamstring ACL reconstruction participated in this study. Bilateral anterior tibial translation (ATT) was recorded using the KT1000 arthrometer, and a robotic testing system was used to assess side-to-side differences in rotational characteristics. Each reconstruction was evaluated to determine how well it mimicked the anteroposterior (AP) and rotational biomechanics of the normal knee. A reconstruction was defined as mimicking the normal knee if ATT and internal rotation (IR) were within 3 mm and 3.5A degrees, respectively.Side-to-side differences in ATT were significantly higher for the SB group (2.2 +/- A 1.4 mm) than the DB group (1.1 +/- A 1.0 mm, P = 0.001). While relative side-to-side differences in IR did not differ between the SB (1.3A degrees) and DB groups (1.1A degrees, P = 0.82), absolute IR differences were significantly less with the DB reconstruction (2.1A degrees vs. 4.7A degrees, P = 0.001). A significantly greater percentage of DB patients (81%, P = 0.0003) had both ATT and IR similar to the normal knee, compared to 34% of the SB patients; however, IKDC subjective scores did not differ between groups. Regardless of technique, patients with the greatest rotational laxity of their non-operative knee demonstrated significantly worse IKDC scores.DB reconstruction resulted in reduced side-to-side differences in both ATT and IR. The DB technique more consistently reproduced the biomechanical profile of the uninjured limb than did the SB technique without increasing the risk of over-constraining the knee.