Comparison Of Different Fixation Methods Of Anterior Cruciate Ligament Reconstruction With Remnant Preservation

Objective : The reconstruction of the anterior cruciate ligament can effectively improve the prognosis,help to restore the range of motion of the knee joint,and help to restore the proprioception of the knee joint.At present,there are four methods of stump fixation,and the specific efficacy of each method has not been determined.To compare the clinical effects of four fixation methods for the residual end of anterior cruciate ligament(ACL)salvage reconstruction.Methods:A retrospective analysis was made of 133 patients who met the inclusion criteria in the orthopedic department of Shengjing hospital from January 2018 to December 2021.All patients used knee arthroscopy to reconstruct the anterior cruciate ligament and were transplanted with autologous tendons.According to the residual end of the anterior cruciate ligament,they were divided into the disability-preserving reconstruction group and the non-disability-preserving reconstruction group.The disability-preserving reconstruction group was further divided into the direct fixation group according to the different residual end scores and different residual end fixation methods The residual tension suspension fixation group,the suture and transplantation tendon fixation group,and the residual sleeve fixation group.All patients were followed up for more than 12 months.The knee joint function and proprioception recovery of patients were evaluated according to the observation data.Results :(1)The Lysholm score and IKDC score of the disability-preserving reconstruction group were better than those of the non-disability-preserving reconstruction group at 3 months and 12 months after operation(P<0.05);(2)The tibia forward displacement distance of the disability-preserving reconstruction group was better than that of the non-disability-preserving reconstruction group at 3 months and 12 months after operation,with statistical difference(P<0.05);(3)The TTDPM value and JPR value of the disability-preserving reconstruction group were better than those of the non-disability-preserving reconstruction group at 3 months and 12 months after operation,with statistical difference(P<0.05);(4)The Lysholm score and IKDC score of the knee joint at 3 and 12 months after operation showed no significant difference between the residual compression fixation group and the residual tension suspension group,followed by the residual suture and tendon transplantation group,and the residual sleeve fixation group was the lowest,with statistical significance(P<0.05);(5)At 3 and 12 months after the operation,there was no significant difference and the smallest difference between the residual compression fixation group and the residual tension suspension group in the tibial forward displacement of the knee joint,followed by the residual suture and tendon transplantation group,and the residual sleeve fixation group was the largest and statistically significant(P<0.05);(6)The TTDPM and JPR values at 3 and 12 months after operation were the smallest and no significant difference between the residual compression fixation group and the residual tension suspension group,followed by the residual suture and tendon transplantation group,and the residual sleeve fixation group was the largest and statistically significant(P<0.05).Conclusion:(1)ACL disability-preserving reconstruction has a better clinical effect than non-disability-preserving reconstruction(2)Of the four types of stump fixation methods,direct fixation and tension suspension of the stump have the best clinical effect,followed by suture of the stump to the transplanted tendon,and sleeve fixation has a poor clinical effect(3)retaining more stumps and synovium can improve the prognosis of ACL disability-preserving reconstruction.