| ObjectiveBecause of its own anatomic characteristics and special functions,the knee joint becomes one of the most easily joint injuries. And the anterior cruciate ligament(ACL) is one of the most common disorders of the knee joint injuries.If the ACL injury is treated incorrect, the injury of meniscus, degeneration of osteoarthritis and other complications will appear.As the improvement of the technique of arthroscope,it has become the primary treatment to reconstructe ACL under arthroscopic. Compared with B-PT-B (bone patellartendon bone), the hamstring tendon autografts is becoming the first choice for ACL reconstruction because of its better biomechanical characteristics and less donor site complications.Although it has become the conventional operation method, the ACL reconstruction by using hamstring tendon autografts also faces a lot of controversy and unknown factors.Such as how to choose the fixation systems,which is the real factor causing the bone tunnel enlargement,and whether there is correlation between the bone tunnel enlargement and the clinical effect. The45cases with ACL rupture were divided into two groups:Group A (25cases) were reconstructed arthroscopically with semitendionosus and gracilis tendons by endobutton; Group B (20cases) were reconstructed arthroscopically with semitendionosus and gracilis tendons by absorbable interference screw.By retrospective studing the clinical materials,we attempt to explore the difference betweent the endobuttone system and the absorbable interference screw system.The content include fixation mode, the factors causing the bone tunnel enlargement,and the correlation between the bone tunnel enlargement and the clinical effect.Methods1.General condition:The45cases with ACL rupture were divided into two groups:Group A (25cases) were reconstructed arthroscopically with semitendionosus and gracilis tendons by endobutton; Group B (20cases) were reconstructed arthroscopically with semitendionosus and gracilis tendons by absorbable interference screw. Group A including17males and8females,aged from18to58,with33.16average.9case was the left and16case was the right.The course of disease was from2weeks to5years with1.72years average. Group B including13males and7females,aged from18to54,with34.2average.7case was the left and13case was the right.The course of disease was from2weeks to4.5years with1.79years average.2. Grouping:The45cases with ACL rupture were divided into two groups:Group A (25cases) were reconstructed arthroscopically with semitendionosus and gracilis tendons by endobutton; Group B (20cases) were reconstructed arthroscopically with semitendionosus and gracilis tendons by absorbable interference screw. 3. Postoperative treatment:3.1Preventing infection:All cases were usded prophylactic antibiotics for about24to48hours。3.2The detumescence,analgesia, and drain:All cases were usded ice compress for24hours after operation,and usded nonsteroidal antiinflammatory drugs to relieve pain. The mean time of drain was2to3days.3.3The functional exercise:The first period is from the first day to the seventh day. The motion range of the knee joint was locked in0°to90°.The knee joint was used passive functional exercise without weight bearing. CPM exercises can be choosed. The second period is from the second week to the thirth week. The motion range of the knee joint was aded to100°,and the knee joint can do the active functional exercise without weight bearing.The thirth period is from the fourth week to the sixth week. To improve the activity amount gradually and do the active functional exercise with weight bearing. The motion range of the knee joint was aded to125°.The fourth period is from the seventh week to the twelveth week.The patients can walk with weight bearing completely. The motion range of the knee joint was aded to140°.The main objective was to strengthen the power of the knee joint.The fifth period is from the fourth month to the sixth month. The main objective was to strengthen the body harmony and the flexibility of the knee joint.4. Physical exam such as Anterior draw test, Lachman test, and Pivot shift test were conducted on all these patients after the surgery. Lysholm knee score was taken before the surgery and during the follow up visit on the sixth month, The diameter and the shape of bone tunnel were measured using X-ray. X-ray of all cases was taken immediately after the reconstruction and on the the sixth month, the results were analyzed.5. The data were expressed by x±s.Statistical software (Spss13.0) was used for statistical analysis. The differences of measurement data including the extent of the tunnel enlargement and the lysholm knee score were compared with the t test.Because of the total cases of the group A and B was less than40, the differences of the incidence rates of the tunnel enlargement was compared with Fisher exact probability.Results1.The general conditions including the average age,gender and the course of disease were analysis.There was no statistical difference between group A and B.2. Postoperative complications in group A included saphenous nerve injury in1case, little vein thrombosis in2cases, knee joint pain in2cases and slight bucking limited in1cases. Postoperative complications in group B included saphenous nerve injury in1case, knee joint pain in1cases and reactivity synovitis in1cases. There was no infection in all cases. The bucking limited was improved by functional exercise,the vein thrombosis and the reactivity synovitis were good recover at last.3. Kee functional scales:3.1The motion of all knee joint was in the normal range.3.2The Pivot shift test were negative in all cases. Lachman test showed2cases were positive in group A and3cases in group B.3.3The lysholm knee score including group A and B were analysis.There was no statistical difference between group A and B.But the statistical difference of the lysholm knee score was significant before and after the reconstruction.4Tunnel enlargement scales:4.1There were18cases in groupA and18cases in group B whose bone tunnel were measured using X-ray.4.2After analysing the incidence rates of the tunnel enlargement, there was no statistical difference between group A and B.4.3After analysing the extent of the tunnel enlargement, there was significant statistical difference between group A and B.And the tunnel enlargement of the group B was bigger.Conclusion1.Hamstring tendon graft is an ideal graft for anterior cruciate ligament reconstruction, and arthroscopic reconstruction using hamstring tendon shows the advantages of less complications on donor-site, less hospitalization time, less hospitalization expense and so on.2. Reconstruction on femoral tunnel using endobutton and absorbable interference screw fixation systems show the advantages of simple manipulation, reliable fixation and able to exercise the joints early.3.We should pay great attention to every stage in order to make the successful operation. And the accurate location and correct direction of the bone tunnels are the key to successful operation. 4. The incidence rate of early tunnel enlargement was a little high using not only the endobutton,but also the absorbable interference screw fixation systems.There was no statistical difference between group A and B. And the extent of the tunnel enlargement was bigger using the absorbable interference screw fixation systems. But there were no correlation between the bone tunnel enlargement and the clinical effect. |
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