A Clinical Study Of Arthroscopic Anterior Cruciate Ligament Reconstruction With Remants And Remaining Bundle Preservation

Objective: To investigate the clinical effcet of the hamstring tendon anterior cruciate ligament reconstruction with remants and remaining bundle preservation.Methods: Since October 2008~October 2009 in our hospital 60 patients (60 knees) underwent hamstring tendon anterior cruciate ligament reconstruction. And all the patiens allowed a follow-up visit, group of Standard ACL reconstruction(Standard group) includes 14 males and 6 females with the average age of 36.4(from 18 to 52), group of chronic injuries ACL reconstruction with remants and remaining bundle preservation(Chronic group) includes 16 males and 4 females with the average age of 38.6(from 18 to 55), group of acute injuries ACL reconstruction with remants and remaining bundle preservation(Acute group) includes 15 males and 5 females with the average age of 30.2(from 18 to 53). Among that, 20 traffic accidents, 19 sprain injuries, 14 sports injuries, 7 crushing injuries. The basis of clinical performance and MRI diagnosis of anterior cruciate ligament injury in 46 cases, with arthroscopic examination and surgery alone anterior cruciate ligament confirmed 60 cases of injury. Arthroscopic of anterior cruciate ligament body of 41 cases of fracture, ligament absence of 11 cases, femoral avulsion 13 cases of point,20 cases of medial meniscus injury. Injury to surgery 5 days to 1 year, average 1 month. Clinical results were evaluatrd according to MRI, Lachman test, knee function and stability, Lysholm, IKDC.Results:1,General Condition:All operations were successful, 60 patients were followed up. All patients were stageⅠincision healed, the patients follow-up X ray shows good position of transplanted tendons. Three groups of patients had no joint adhesion, wound infection, graft fracture, internal fixation screw loose, tunnel widening, patella fracture, joint fibrosis, synovitis, deep venous thrombosis and other complications, but also non-concurrent one-eyed abnormal fetal malformation.2,Comparison of knee joint stability and activity: According to evaluation after 6 months of rehabilitation, Standard group: Lachman test (-) 17 cases, (±) 3 cases, 2 cases compared with the contralateral extensor angle difference of about 5°, 5 cases contralateral knees difference of about 5°; Chronic group: Lachman test (-) 19 cases, (±) 1 cases, 2 cases compared with the contralateral extensor angle difference of about 5°, 4 cases contralateral knees difference of about 5°; Acute group: Lachman test (-)20 cases, 1 cases compared with the contralateral extensor angle difference of about 3°, 4 cases contralateral knees difference of about 5°, between every two of the three groups Lachman test and range of motion was no significant difference(P>0.05). The original symptoms disappeared or reduced. Subjective assessment of knee function improved treatment results were satisfactory.3,Composite score: According to the rehabilitation evaluation of 2,3,6 months after operation, Lysholm knee score obtained. The preoperative Lysholm score of three groups showed no difference(P>0.05).Standard group 2 months after reconstruction scores were marked higher than preoperative scores(P<0.01), 3 months scores notable higher than 2 months(P<0.01), 6 months scores significantly higher than 3 months(P<0.01); Compared with Standard group, Acute group and Chronic group scores that 2,3 months after reconstruction were significantly higher(P<0.01);Compared with Chronic group, Acute group scores that 2,3 months after reconstruction were marked higher(P<0.05);6 months postoperation scores has no significant difference. According to the rehabilitation evaluation of 6 months after operation, IKDC score obtained. IKDC ranges from A to D, A(normal), B(nearly normal), C(abnormal), D(severely abnormal). Standard group: IKDC score normal level of activity in 17 patients (85%); Chronic group: IKDC score normal level of activity in 18 patients (90%); Acute group: IKDC score normal level of activity in 19 patients (95%); three groups showed no difference(P>0.05). Patients have no significant limitation of activity, most patients have returned to pre-injury state of motion.4,Comparison of measure of the recovery knee proprioception: Measurement of three groups compared the ability to copy test of postoperation knee when the flexion in 15°and 30°passive position. Results: Standard group, Completely passive position copied 10 cases (50%); Chronic group, Completely passive position copied 14 cases (70%); Acute group, Completely passive position copied 20 cases (100%); The test showed that Acute group marked better than Chronic group(P<0.05), Chronic group notable better than Standard group(P<0.05), Acute group significantly better than Standard group(P<0.01).Results among three groups of the differences of the threshold measuremen passive motion detection sensory location of the uninvolved when knee 30°flexion: Acute group lower than Chronic group(P<0.05); Chronic group lower than Standard group(P<0.05); Acute group significantly lower than Standard group(P<0.01). Conclusion: 1,Acute phase of the ACL injury is the best time to implement reconstruction with remants and remaining bundle preservation, it`s necessary to get early diagnosis and implement reconstruction.2,ACL tibial stump retained can promote early graft revascularization and re-ligament, is conductive to the nerve receptors of migration tendon to grow up and restore proprioception, to guide the ligament anatomical positioning of the tunnel and close the transparent between tendon and tunnel, and promote bone-tendon healing, create favorable conditions for the completely ACL reconstruction.3,Proprioception of the Chronic group still exists and plays a important role, surgery should also be retained stump.4,Arthroscopic autologous four shares of ST/G ACL reconstruction is the better way to restore the knee stability and is an effective manner to treat acute and chronic ACL injury. Accurate intraoperative tibial and femoral tunnel position and graft fixation is the key to successful surgery. After the reconstruction, correct and rational functions rehabilitation is an important part to ensure the effection.