The Clinical Evaluation To The Patial Anterior Cruciate Ligament Reconstruction

BackgroundAnterior cruciate ligament (ACL)is very important facters to maintain the stability of the knee. Because of special anatomical location ,the ACL is easy to rupture. There were 50,000 reconstruction of the ACL in USA every year[1]. Now more and more people joined sports and other social activities, the rate of ACL rupture is increasing year by year. with the development of the technology and technique in ACL reconstruction, doctors has gotton more and more experiences. Now it is a standard model to reconstruct the ACL with the arthroscopy. there are many ways to replace the ACL, like the attologous patella ligament, hamstring ligament, allograft ligament, and artificial ligament. But it is a gold standard to reconstructed the ACL using the bone–patellar tendon-bone because of its stable clinical outcome.With the intensive researching on the damage of ACL, Now more and more doctors put special sights on partial damage of ACL.in fact some doctors began to treat the partial damage of ACL with arthroscopy. Most of the doctors think we should do the ACL reconstruction if the damage of the ACL is more than 50%, because the knee will become the instability if we do not it. Some of doctors think the partial damage of the ACL can acured by itself in the early period. it lead to the propable complication and increasing injury if we do the operation for partial ACL damage. The most important is lost the chance to acure by itself. the key point is how to keep the balance between preserving the ability of ACL to acure itself and improving the stability of the knee. Partial ACL reconstruction with the allograft of Bone-Patellar Tendon-Bone is a good solution for this question. It decreased the probable injury and complication. At same time it preserving the ability for residual ACL tissue curing it self. but there is no report abou whether the partial ACL reconstruction afford enough stability.Bone-Patellar Tendon-Bone had a powerful intensity at the first time of the planted, then it would be erosion and absorption. then the intensity become weak.and there will be more erosion and asorption in allograft. With the revascularization, recelluation and renervation, the allograft is reconstructed. the revscularization was throught the most important step in the early periods. Revascularization can promote the reconstruction and increase the successful rate in the long run. now more and more reseach are doing about the fuction of the residual ACL. the residual ACL tissue can promote revascularization and recelluation, then improving the reconstruction probably, but there was no report about whether the residual ACL can promote revascularation.Purpose and methods30 cases from January, 2006 to December, 2007 is divided to 2 groups at randomly. group A was treated with single bundle reconstrution, group B is treated with partial ACL reconstruction. Both group were followed up. the fuction of the knee is evaluated by the IKDC,JOA,Tegner,Lyshoml preoperatively and postoperatively. Compared the score of both groups to evaluate the diferrence between the 2 groups. Then the patients in both goups were treated a diagnostic second-arthroscopy. take the pictures of the graft when the asmach is loosen. To evaluate the colour degree using the photoshop software, then made the curve of the red colour area-time related. Finally to evaluate whether the residual ACL is useful for the revascularization.Reults1.compared the score of the IKDC,JOA,Tegner,Lyshoml in group A,B by SPSS soft ware. The score of JOA In group A is encreasing from 40.9±3.2 preoperatively to 85.3±4.9 postoperatively. The score of the JOA in group B is increasing from 39.0±3.8 preoperatively to 88.3±3.3postoperatively. the score of Lyshoml in group A increasing from 40.9±3.3 preoperatively to 85.3±4.9 postoperatively. The score of the Tegner and Lyshoml is evaluated by ridit. It find the score of the IKDC,JOA,Tegner preoperatively and postoperatively had siganificant difference. but the score of the IKDC,JOA,Tegner,Lyshom had not siganificant difference between the group A and group B.there was siganificant difference between group A and group B according the Lyshoml. there was siganificant difference too in the score of the climing stairs and quatting.2.group A and group B were teated with a second-arthrosopy examinlation. Take the pictures of the graft with the inteval of 5 minutes until 3 minutes finished. Evaluated the colour degree of the same place with the photoshop 10.0 software and made a curve of the colour degree-time related. RGB is defined a single colour ofλR=700.0nm,λG=546.1nm,λB=435.8nm. compared the colour degree of the red in 3 different parts in both group, it shows that the colour degree in group B is better than the one in group A at the time of the 25-60 seconds. There is no siganificant difference about colour degree in group A and group B at the time of 3 minutes.Conclusion1.both tranditional single bundle reconstruction with attograft of bone–patellar tendon-bone and partial reconstruction with the allograft of bone–patellar tendon-bone can get a good clinical outcome.2.the proprioception in partial reconstruction with the allograft of bone–patellar tendon-bone is bettrer than the one in group which treated single bundle reconstruction with the attograft of bone–patellar tendon-bone.3.because of he preserving the residual tissue of the ACL, the proprioception in partial reconstruction with the allograft of bone–patellar tendon-bone is bettrer than the one in group which treated single bundle reconstruction with the attograft of bone–patellar tendon-bone.4.revascularization in group which treated with the partial reconstruction is better than the one in group A.