| ObjectiveThe anterior cruciate ligament(ACL)is the important structure of the most complex and largest knee joint in the human body,whose damage will not only destroy the integrity of the knee structure,but also affect the biomechanics of the knee joint.At the same time,the lack of effective and timely treatment after ACL injury,due to the influence of their poor self-healing ability and other factors,will not only be secondary to traumatic arthritis,but also will cause serious damage to the function of the knee joint,thus seriously threatening the physical and mental health of patients,and even the quality of life.Up to now,ACL knee reconstruction under microscope is the most effective treatment Mode.But in this treatment,the key problem facing clinicians is graft selection.At present,the choice of graft in ACL reconstruction is still controversial.Therefore,the clinical efficacy of autologous,mixed and simple ligament advanced reinforcement system(LARS)in ACL reconstruction was compared and analyzed.Methods132 patients who were admitted to orthopedic department of a hospital during January 2017～January 2020 and underwent ACL reconstruction were divided into artificial group,autologous group and mixed group according to the different graft selection,44 cases in each group.Among them,patients with the artificial group were treated with LARS artificial ligament,and the autologous group took the medial half tendon and femoral tendon of the calf tibial nodules and woven into autologous ligament for treatment,while the mixed group was treated with semi-tendon,femoral tendon and LARS artificial ligament graft.At different preoperative and postoperative time points,Lysholm score,Lachman test and Tegner score were evaluated.At the same time,the bone tunnel expansion value,ligament growth factors,postoperative knee joint function,quality of life,recovery time,the occurrence of postoperative complications and other conditions were observed.Results(1)Postoperative Lysholm scores were higher compared to preoperative groups(P<0.05).Mixed group had higher Lysholm scores at each time point compared to artificial and autologous group(P<0.05).The postoperative Lysholm scores of artificial group were higher than that of autologous group(P<0.05)at each time point.The excellent and good rates were 68.18%,93.18%,88.64%in the autologous group,mixed group and artificial group,respectively.There was statistical difference among the three groups(P<0.05).The mixed group was higher than the autologous group(P<0.05),the artificial group was higher than the autologous group(P<0.05),and the mixed group was higher than the artificial group but there was no significant difference(P>0.05).(2)2 years after operation,The normal number in the Lachman test of mixed group and artificial group was higher than that of autologous group(P<0.05),but there was no statistical difference between mixed group and artificial group(P>0.05).(3)The postoperative International Knee Documentation Committee(IKDC)and Tegner scores were all higher(P<0.05).All the scores in the mixed group were higher than those in the autologous group and the artificial group(P<0.05)at each time point.Compared with the autologous group,the artificial group had higher postoperative scores(P<0.05).(4)The degree of KT1000 knee movement in each group was less than before(P<0.05)at each time point.After 1 year and 2 years,the knee movement of the mixed group was less than that of the autologous group and the artificial group(P<0.05).Compared with the autologous group,the knee joint movement of artificial group was less(P<0.05).(5)At 1 year and 2 years postoperative,the enlarged value of bone tunnel in each group was higher than that of intraoperative group(P<0.05).At 1 year,compared to the autologous and artificial groups,the enlarged value of bone tunnel in mixed group was less(P<0.05),what’s more,there was no statistical difference between the autologous and artificial groups(P>0.05).(6)Higher postoperative conversion growth factor-β1(TGF-β1),basic fibroblast growth factor(bFGF)compared to preoperative groups(P<0.05).The postoperative TGF-β1、bFGF of the mixed group was higher than that of the autologous group and the artificial group(P<0.05).Artificial group was higher than autologous group(P<0.05).(7)The knee joint percentage scoring system(HSS)scores of each group after half a year,one year and two years were higher than those before operation(P<0.05).There were significant differences in HSS scores of each group in six months,one year and two years after operation(P<0.05).Among them,the mixed group and the artificial group were higher than the autologous group,at the same time,the mixed group was higher than the artificial group(P<0.05).Two years after surgery,excellent and good rates were higher in mixed and artificial group(P<0.05),but there was no statistical difference between the two groups(P>0.05).(8)Compared with the Concise Health Scale Short From 36 health Survey Questionnaire(SF-36)score of 2 years after operation,the mixed group and the artificial group had higher scores in each dimension,while the mixed group had higher scores than the artificial group(P<0.05).(9)The daily activity recovery time,movement recovery time,walking with stick time and walking without stick time of mixed group and artificial group were shorter than that of autologous group(P<0.05).The daily activity recovery time and movement recovery time of the mixed group were shorter than that of the artificial group(P<0.05),but there was no statistical difference in walking with stick time and walking without stick time between the two groups(P>0.05).The incidence of complications was lower in mixed group and artificial group than in autologous group(P<0.05).There was no significant difference in the incidence of complications between the mixed group and the artificial group(P>0.05).ConclusionAfter 2 years of perioperative follow-up,it was found that when the ACL was reconstructed under arthroscopy,mixed ligaments and artificial ligaments were used to repair it,which not only had higher excellent and good rate,but also was more ideal in improving the function of knee joint.In the near future,mixed ligaments can improve knee function and increase knee motion.At the same time,postoperative bone tunnel expansion increased less.In addition,the application of mixed ligaments can also increase ligament growth factor.Moreover,mixed ligaments have good effects in improving quality of life,shortening exercise recovery time and reducing the incidence of complications.Based on this study,we believe that the mixed ligament can be used as the primary graft for clinical,and is more helpful in helping patients return to normal work and life as soon as possible.However,the conditions of ACL injuries may limit the use of mixed ligaments,and the high medical costs are practical considerations. |
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