| BackgroundAt present,arthroscopic reconstruction of ACL is recognized as the most effective way for ACL rupture.However,whether to retain tibial stump during ACL reconstruction is still inconclusive in the views of scholars at home and abroad.ObjectiveTo evaluate the kinematic characteristics and efficacy of knees following anterior cruciate ligament(ACL)restoration with remnant preservation,and to guide clinical treatments and choose better surgical procedures.MethodsThe clinical data of 50 patients with ACL deficiency,which were divided into two groups:the remnant preservation group(n=25)and the non-remnant preservation group(n=25),and 25 healthy volunteers from August 2017 to March 2018 were analyzed.The six degrees of freedom(6-DOF)ranges of knee joints and kinematic function score were calculated by Opti_knee.Lysholm score,International Knee Documentation Committee(IKDC)score,Tegner score,proprioceptive(position and motion)data and the distance error from the center of the tibial tunnel inner mouth to the center of the footprint of the anterior horn ligament of the lateral meniscus were also analyzed.The statistical differences of 6-DOF in each group were analyzed by two-way ANOVA and t-test.The statistical differences of basic data in each group were analyzed by one-way ANOVA and t-test,while the counting units were tested by chi-square test.The kinematic function scores,subjective scores,proprioceptive data and center distance errors were detected by t-testResultsIn remnant preservation group,the ranges of internal-external rotation,flexion-extension rotation at 3 months and the range of internal-external rotation at six months were lower than those in control group(t=-2.365,P=0.022;t=-3.123,P=0.003;t=-2.419P=0.019).In non-remnant preservation group,the ranges of adduction-abduction rotation,internal-external rotation,flexion-extension rotation,proximal-distal translation,medial-lateral translation at 3 months,the ranges of internal-external rotation,flexion-extension rotation at 6 months and the range of internal-external rotation at 12 months were lower than those in control group(F=9.554,P=0.020;t=-5.067,P<0.001;t=-5.119,P<0.001,t=-2.655,P=0.011;t=-2.863,P=0.006;t=-3.516,P=0.001;t=-4.100,P<0.001;t=-3.076,P=0.003),while the range of anterior-posterior translation at 6 months was larger than control group(t=2.464,P=0.017).Besides,the range of internal-external rotation,flexion-extension rotation at 3 months and the range of flexion-extension rotation at 6 months in non-remnant preservation group were also lower than remnant preservation group at the corresponding time(t=2.512,P=0.015;t=2.428,P=0.019;t=2.267,P=0.028).Kinematic function score of operative knees at 3 months in the remnant preservation group was higher than that in the non-remnant preservation group(t=2.272,P=0.028).The Lysholm score at 3 months and 6 months and the IKDC score at 3 months in the remnant preservation group were higher than the non-remnant preservation group(t=4.706,P<0.001;t=2.106,P<0.040;t=2.987;P=0.004),and the medial-lateral distance error in remnant preservation group was smaller than non-remnant preservation group(t=-2.600,P=0.012).The position perceptions of 60° in the remnant preservation group were smaller than that in the non-remnant preservation group at 3 and 6 months after operation(t=-2.063,P=0.045;t=-2.147,P=0.037).ConclusionThe kinematic characteristics of the remnant preservation group are closer to those of normal people and the rehabilitation of the remnant preservation group is better than that of non-remnant preservation group in the early and mid-term period. |
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