半月板Ramp损伤修复在预防前交叉韧带重建术后残留不稳中的作用
简介
一项前瞻性对照研究纳入50例ACLR患者，一组联合半月板ramp lesion修复（A组），另一组单纯ACLR且无ramp lesion（B组）。术后6个月随访显示，A组Lachman试验阴性率（88% vs. 72%）及轴移试验阳性率（16% vs. 40%）均显著优于B组，且Lysholm评分（93.6 vs. 88.9）和IKDC正常率（56% vs.…
英文摘要
INTRODUCTION: Anterior cruciate ligament reconstruction (ACLR) is a common procedure done to regain knee stability, but even after the technical success of the operation; some patients still experience residual instability. Anterior cruciate ligament (ACL) injuries are regularly accompanied by meniscal ramp lesions, which concern the posteromedial meniscocapsular junction and can lead to a persistent anterior and rotational laxity in case of inadequate treatment. Whether ramp lesion repair could help in avoiding residual instability after ACLR is a controversial issue. MATERIALS AND METHODS: The proposed study is a prospective observational comparative study involving 50 participants who planned to undergo arthroscopic ACLR as a primary operation in a tertiary care unit. The findings during intraoperative were used to categorize the patients into two groups: Group A (ACLR and concomitant ramp lesion repair; n = 25) and Group B (isolated ACLR and no ramp lesion; n = 25). Lachman test and pivot-shift test were used to measure post-operative knee stability, and Lysholm Knee Scoring Scale and subjective International Knee Documentation Committee (IKDC) score at six months follow-up were used to measure functional outcomes. RESULTS: Group A exhibited a high rate of post-operative knee stability, with 88% having a negative Lachman test in comparison to Group B (72%), with residual pivot-shift positivity being significantly low in Group A (16%) compared to Group B (40%) (P = 0.03). The ramp repair group also performed better in terms of functional outcomes, having a higher mean Lysholm score (93.6 ± 4.8 vs. 88.9 ± 6.2) and a high percentage of normal IKDC score (56 vs. 32). The parameters of residual instability were much lower in patients who received ramp lesion repair. CONCLUSION: Meniscal ramp lesion repair done together with ACLR enhanced substantially residual knee instability and short-term functional outcomes. This can be improved by systematic assessment and proper management of ramp lesions during ACLR to increase the stability of the knee post-surgery and maximize patient outcomes.