使用腓骨长肌分叉肌腱自体移植物进行 MCL 增强术可令人满意地恢复膝关节的稳定性,且不会影响足部功能,同时进行前交叉韧带重建的失败率也很低。

IF 3.3 2区 医学 Q1 ORTHOPEDICS
Nico Hinz, Maximilian Michael Müller, Lena Eggeling, Tobias Drenck, Stefan Breer, Birgitt Kowald, Karl-Heinz Frosch, Ralph Akoto
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引用次数: 0

摘要

目的:在前交叉韧带(ACL)重建过程中解决 2 级和 3 级内侧不稳对于降低前交叉韧带移植失败的风险至关重要。本研究采用微创内侧副韧带(MCL)增量技术,使用腓骨长肌分裂肌腱自体移植物,将其固定在股骨深层 MCL 插入处和胫骨浅层 MCL 插入处:该前瞻性、纵向、单中心病例系列包括因前内侧不稳而同时接受初级或翻修前交叉韧带重建术的患者。对术前和术后1年的临床检查,如胫骨前移和内侧不稳的rolimeter测试、膝关节(国际膝关节文献委员会主观膝关节表格[IKDC]、Lsyholm、膝关节损伤和骨关节炎结果评分[KOOS])和足部功能评分(美国骨科足踝协会评分[AOFAS])以及并发症进行了分析:31名患者的平均随访时间为(13.5±2.6)个月,平均年龄为(27.8±9.6)岁。从术前到1年随访期间,胫骨前移的侧向差异明显改善,前交叉韧带重建失败率为6.5%。在屈曲30°的外翻压力测试中,没有患者出现2级或3级内侧不稳。从术前到术后1年随访,膝关节功能评分均有显著改善:IKDC(48.9 ± 26.9- 71.3 ± 11.5,P 结论:术后 1 年,膝关节功能评分明显改善:在术后1年的随访中,使用腓骨长肌劈裂肌腱自体移植物对同时接受前交叉韧带重建的患者进行MCL增量术,可令人满意地恢复膝关节稳定性,前交叉韧带重建失败率较低,且不会明显影响足部功能:IV级治疗研究;病例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MCL augmentation using a peroneus longus split tendon autograft satisfactorily restores knee stability with no impairment in foot function and with a low failure rate for concurrent ACL reconstruction.

Purpose: Addressing grade 2 and 3 medial-sided instabilities during anterior cruciate ligament (ACL) reconstruction is crucial to reduce the risk of ACL graft failure. This study introduced a minimally invasive, medial collateral ligament (MCL) augmentation technique using a peroneus longus split tendon autograft, which was fixed to the femoral deep MCL insertion and tibial superficial MCL insertion.

Methods: This prospective, longitudinal, single-centre case series included patients who underwent MCL augmentation concurrent with primary or revision ACL reconstruction due to anteromedial instability. Preoperatively and at 1-year follow-up, clinical examinations, such as rolimeter test of anterior tibial translation and medial instability, knee (International Knee Documentation Committee subjective knee form [IKDC], Lsyholm, Knee Injury and Osteoarthritis Outcome Score [KOOS]) and foot function scores (American Orthopaedic Foot and Ankle Society score [AOFAS]) and complications, were analyzed.

Results: Thirty-one patients with a mean follow-up of 13.5 ± 2.6 months and a mean age of 27.8 ± 9.6 years were included. The side-to-side difference for anterior tibial translation significantly improved from preoperative to 1-year follow-up with an ACL reconstruction failure rate of 6.5%. No patient retained a grade 2 or 3 medial instability on valgus stress testing with 30° flexion. Significant improvements from preoperative to 1-year postoperative follow-up were observed in knee function scores: IKDC (48.9 ± 26.9- 71.3 ± 11.5, p < 0.001) and Lysholm (59.9 ± 28.5-80.5 ± 11.2, p = 0.002) as well as KOOS pain, ADL, sport and QoL, each reaching the respective minimal clinically important difference values. The foot function score AOFAS showed no significant impairment (100 ± 0-99.3 ± 2.5, p = 0.250). Complications included cyclops lesions of ACL reconstruction in three patients.

Conclusion: At 1-year follow-up, MCL augmentation using a peroneus longus split tendon autograft for patients simultaneously undergoing ACL reconstruction satisfactorily restores knee stability, has a low ACL reconstruction failure rate and does not significantly impair foot function.

Level of evidence: Level IV therapeutic study; case series.

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来源期刊
CiteScore
8.10
自引率
18.40%
发文量
418
审稿时长
2 months
期刊介绍: Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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