| 摘要 |
A prospective review was undertaken at this institution after using a procedure
involving use of the central one-third of the patellar ligament as a free, autogenous graft for early reconstruction of a ruptured acute anterior cruciate ligament (ACL) for 48 patients. The patients, 42 males and 6 females with a mean age of 21 years (range, 19 to 32), were followed for 2 to 5 years (mean, 30 months). Patients were evaluated by physical examination, with a K-T 1000 arthrometer, radiographs and the Cybex 11 + dynamometer, as well as by obtaining a Lysholm score for rating the ligament. Preoperatively, there were 42 patients with joint swelling. Range of motion in flexion was less than 120。in 34 cases. Less than 10。of extension was noted in 23 cases. Under anesthesia, stability examination showed 100% of the patients positive in the Lachman test, 82% positive in the lateral pivot shift test. Associated injury of the medial collateral ligament was noted in 12 cases and, in 25 cases, there was meniscal tear. The surgical procedure was approached by two incisions through a mini-arthrotomy of the graft defect and the rear entry technique. After operation, the knee was put in full extension in 30 cases and 30。of flexion in 18 cases. Postoperative care to inelude early and limited protective motion was encouraged. Postoperatively, the average scale of Lysholm scores was 85 points. Clinical examination demonstrated that 82% had less than 1 + Lachman test; 91 % had a negative pivot shift. KT-1000 arthrometer revealed that 88% of the cases had less than 3 mm difference. Mean quadriceps muscle strength loss was on an
average of 18%. Loss of extension greater than 10° was noted in three cases and flexion less than 125。in four. Although early reconstruction of acute ACL tear is reliable to achieve knee stability, no matter how aggressive the rehabilitation attempts, the risk of loss of motion reaches high percentage.
To prevent loss of motion, delaying acute reconstruction until the acute inflammatory phase of the injured knee has ended may be the best option. |
