Observations on a Retrieved Patellar Tendon Autograft Used to Reconstruct the Anterior Cruciate Ligament: A Case Report
Observations on a Retrieved Patellar Tendon Autograft Used to Reconstruct the Anterior Cruciate Ligament: A Case Report
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回收的自体髌腱用于重建前十字韧带的观察：病例报告
DOI：
10.2106/00004623-200208000-00020
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
E. Mindell
中科院分区：
文献类型：
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作者：
B. Delay;B. Mcgrath;E. Mindell
撕裂的前交叉韧带通常用中央第三骨-髌腱-骨自体移植物替代1。许多动物模型已被用于研究重建后自体髌腱移植物的血运重建过程2 -8。然而，只有活检材料，通常是浅表的，从成功运作的人类前交叉韧带重建已被评价9 -13。
我们在此报告一例26岁的运动员，18个月前，前交叉韧带撕裂，用自体骨-髌腱-骨移植物替换，尸检时取出了整个膝关节。据我们所知，这是第一个这样的分析回收髌腱自体移植物已被用来取代前交叉韧带。
一名26岁的男子在打篮球时撕裂了前十字韧带。由于复发性不稳定，三年后进行了手术。术前X线片显示正常结果。对麻醉下的患者进行检查，结果显示Lachman试验为2+，轴移阳性。关节镜检查证实前交叉韧带完全断裂，外侧半月板撕裂，内侧半月板桶柄状撕裂。切除外侧半月板撕裂，并切除撕裂的内侧半月板。在关节镜直视下，采用双切口技术，使用中央第三骨-髌腱-骨自体移植物置换撕裂的前交叉韧带。在髁间窝的后外侧，通过前路使用弯锉形成一个5 - 6 mm深的凹槽。将自体移植物穿过胫骨隧道，并使用单个小碎片AO螺钉将髌骨段固定到股骨远端部分的后皮质。将移植物的髌腱部分定位在股骨侧的后外侧锉槽中。
Torn anterior cruciate ligaments are commonly replaced with central-third bone-patellar tendon-bone autografts1. Many animal models have been used to study the revascularization process of patellar tendon autografts after reconstruction2-8. However, only biopsy material, usually superficial, from successfully functioning human anterior cruciate reconstructions have been evaluated9-13.
We are reporting a case in which the entire knee joint was retrieved at autopsy on a twenty-six-year-old athlete in whom a torn anterior cruciate ligament had been replaced with a central-third bone-patellar tendon-bone autograft eighteen months earlier. To our knowledge, this is the first such analysis of a retrieved patellar tendon autograft that had been used to replace the anterior cruciate ligament.
A twenty-six-year-old man tore an anterior cruciate ligament while playing basketball. Because of recurrent instability, surgery was performed three years later. Preoperative radiographs revealed normal findings. Examination with the patient under anesthesia revealed a result of 2+ on the Lachman test and a positive pivot shift. Arthroscopic examination confirmed a complete rupture of the anterior cruciate ligament, a torn lateral meniscus, and a bucket-handle tear of the medial meniscus. The lateral meniscal tear was resected, and the torn medial meniscus was excised. A central-third bone-patellar tendon-bone autograft was used to replace the torn anterior cruciate ligament under arthroscopic visualization with use of a two-incision technique. A 5 to 6-mm-deep groove was fashioned through an anterior approach with use of a curved rasp in the posterolateral aspect of the intercondylar notch. The autograft was passed through a tibial tunnel, and the patellar bone segment was secured to the posterior cortex of the distal part of the femur with a single small-fragment AO screw. The patellar tendon portion of the graft was positioned on the femoral side in the posterolateral rasped groove in the …