关节镜下单束重建联合残端组织修复技术治疗前交叉韧带损伤
简介
本研究回顾性分析62例关节镜下ACL单束重建患者的临床资料，根据术中ACL胫骨残端Sherman分型分组：对照组（Sherman Ⅲ/Ⅳ型，32例）行腘绳肌腱单束重建并保留残端形成袖套包裹移植物；观察组（Sherman Ⅰ/Ⅱ型，30例）在重建同时将残端缝合修复至股骨髁间窝外侧壁以恢复张力。随访9~12个月，观察组无Cyclops综合征或半月板损伤等并发症。…
英文摘要
OBJECTIVE: To explore short-term efficacy of technique of single-bundle anterior cruciate ligament (ACL) reconstruction combined with residual end repair and suturing under arthroscopic. METHODS: From February 2020 to February 2024, clinical data of 62 patients with ACL injury who underwent single-bundle residual preservation reconstruction were retrospective analyzed, including 36 males and 26 females;aged from 16 to 58 years old with an average of (35.7±11.0) years old;patients were divided into two groups based on classification of tibial residual end of ACL observed during arthroscopic. In control group (Sherman type Ⅲ/ Ⅳ), there were 32 patients, including 20 males and 12 females;aged from 17 to 58 years old with an average of (34.88±11.40) years old;treated with single-bundle hamstring tendon reconstruction using residual tibial portion of ACL, and the retained residual part formed a sleeve-like covering for the reconstructed ligament. In observation group (Sherman typeⅠ/Ⅱ), there were 30 patients, included 16 males and 14 females;aged from 16 to 55 years old with an average of (36.53±10.57) years old;during the reconstruction of hamstring tendon single bundle, ACL stump was repaired and sutured to lateral wall of intercondylar fossa of femur to restore the tension of tibial ACL stump tissue. The occurrence of postoperative complications were observed;the stability of knee joint was evaluated by pivot shift test, Lachman test, and KT-1000 bilateral knee anterior laxity difference at 9 months after operation;knee joint function was assessed by International Knee Documentation Committee (IKDC) score and Lysholm score. RESULTS: All patients were followed up from 9 to 12 months with an average of (10.5±1.6) months. In control group, 1 patient was developed Cyclops syndrome without further surgery;1 patient was suffered from longitudinal tear of medial meniscus, which was cured after the modified Lemaire anterior-lateral ligament reinforcement surgery and meniscus repair;and there were not corresponding complications in observation group. There was no statistically significant difference in positive rates between two groups of axial displacement tests (P>0.05);the positive rate of Lachman test in control group (10/32) was higher than that in observation group (3/30), and the difference was statistically significant (P<0.05);at 9 months after operation, anterior laxity of both knees of KT-1000 device in control group (1.71±1.02) mm was greater than that in observation group (1.22±0.81) mm, and the difference was statistically significant (P<0.05). At 9 months after operation, IKDC score of control group was (88.21±6.50) points, which was lower than that of observation group (93.10±4.71) points, and the difference was statistically significant (P<0.05);Lysholm score of control group was (92.11±4.32) points, which was lower than that of observation group (96.42±3.13) points, and the difference was also statistically significant (P<0.05). CONCLUSION: The combined ACL single-bundle reconstruction and residual stump repair technique significantly improves early stability of knee joint and enhances knee joint function after operation, achieving better clinical outcomes. It is particularly suitable for Sherman typeⅠ/Ⅱpatients with good residual stump quality on tibia side of ACL. This technique restores tension of natural ACL tissue, providing an optimized treatment method for ACL reconstruction. However, the surgical difficulty and benefit-risk ratio need to be balanced due to obstruction of ACL residual stump field of view.