The mechanical characteristics and early-stage clinical effects of double bundle anterior cruciate ligament reconstruction with femoral direct fiber insertion

Q4 Medicine

中华骨科杂志 Pub Date : 2020-04-01 DOI:10.3760/CMA.J.CN121113-20200225-00103

Xian-Xiang Xiang, Chungang Zhang, Weiming Wang

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Abstract

Objective To investigate the finite element analysis and early-stage clinical effects of double bundle anterior cruciate ligament (ACL) reconstruction with femoral direct fiber insertion. Methods From June 2016 to June 2017, a total of 26 cases of ACL reconstruction were analyzed retrospectively, including 15 males and 11 females, mean age 30.5±4.6 years. All the patients underwent ACL reconstruction by the same operator. The early-stage clinical effects were evaluated by the finite element analysis, pivot shift test, Lachman test, preoperative and postoperative IKDC score, Lyshlom score, KT-2000, 3D-CT and MRI. Results The finite element analysis confirmed theoretically that the double bundle ACL reconstruction with femoral direct fiber insertion could restore the stability and biomechanics of knee effectively. The results of pivot shift test were negative, and the Lachman test were negative except one first-stage positive after operation. 3D-CT showed that the bone tunnel was located in the direct fiber area. MRI showed clearly the ACL of double bundle after operation. Lysholm score increased from 56.5±3.6 pre-operation to 61.9±3.2 at three months after operation, and up to 88.5±2.0 two years after operation with statistically significant difference (F=824.72, P<0.001). IKDC score increased from 48.3±2.8 before operation to 58.0±2.0 at three months after operation, and to 92.5±2.6 at two years after operation with statistically significant difference (F=2 256.66, P<0.001). KT-2000 side-side difference decreased from 5.6±0.7 mm to 1.6±0.5 mm at three months after operation, and to 1.5±0.6 mm at two years after operation with statistically significant difference (F=389.14, P<0.001). Conclusion The double bundle ACL reconstruction with femoral direct fiber insertion can effectively restore the stability and the biomechanical environment of knee joint with satisfied early-stage clinical effects. Key words: Anterior cruciate ligament; Reconstructive surgical procedures; Finite element analysis

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股纤维直接插入双束前交叉韧带重建术的力学特点及早期临床效果

目的探讨股纤维直接插入双束前交叉韧带重建的有限元分析及早期临床效果。方法回顾性分析2016年6月至2017年6月26例ACL重建患者，其中男性15例，女性11例，平均年龄30.5±4.6岁。所有患者均由同一术者进行ACL重建。采用有限元分析、pivot shift试验、Lachman试验、术前术后IKDC评分、Lyshlom评分、KT-2000、3D-CT和MRI评价早期临床效果。结果有限元分析从理论上证实股纤维直接插入双束前交叉韧带重建能有效恢复膝关节的稳定性和生物力学性能。除1例术后一期阳性外，枢轴移位试验均为阴性，Lachman试验均为阴性。3D-CT显示骨隧道位于直达纤维区。术后MRI显示双束前交叉韧带清晰。Lysholm评分由术前的56.5±3.6升至术后3个月的61.9±3.2，术后2年升至88.5±2.0，差异有统计学意义(F=824.72, P<0.001)。IKDC评分由术前48.3±2.8分增至术后3个月时的58.0±2.0分，术后2年的92.5±2.6分，差异均有统计学意义(F=2 256.66, P<0.001)。术后3个月KT-2000侧侧差由5.6±0.7 mm降至1.6±0.5 mm，术后2年降至1.5±0.6 mm，差异均有统计学意义(F=389.14, P<0.001)。结论股纤维直接插入双束前交叉韧带重建能有效恢复膝关节的稳定性和生物力学环境，早期临床效果满意。关键词:前交叉韧带;重建外科手术;有限元分析

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