| Posterior cruciate ligament injury is a kind of serious knee injury in joint surgery. The morbidity of it takes up about 3.4%-20% of whole ligament injury of the knee. The reconstruction of posterior cruciate(PCL) ligament can effectively prevent other intra-articular structures from being further injured, restore normal movement to the knee joint and even prevent joint degeneration. Inside the knee joint and outside the synovium of joint is posterior cruciate ligament, which is on average 38 mm long and 13 mm wide. What is more, it starts from the back of tibia eminentia intercondyloidea. Finally, it ends within the fermoral condyles with oblique line distribution. And the stop point is dispersed into arc. At present, in anatomy research, usually posterior cruciate ligament is divided into two parts: the AM and PL bundles. The intensity of former is stronger than the latter(about 1.5 times), and its cross- sectional area is about 2 times of the latter. The PCL, together with meniscofermora ligaments before and after the PCL, play a role in limiting the tibia back. However, the PCL is more important than meniscofermora ligaments. When the knee flexion is 30-90 degree, afterload of the PCL is no less than 85%. According to the research, compared with normal knee, when the PCL rupture happened and bending knee with 90 degree, tibia has a posterior displacement with a maximum 200 mm, showing the joint instability. When the start point of the AM femoral condyle occurs anteriorly;tibial-attachment is outside, all bundles of ligament are strained in bending position and of laxity in extending position. On the contrary, the opposite was the case when the PL femoral condyle occurs posteriorly. Theoretically, these anatomical characteristics indicate that for patients with PCL injury, it is difficult to recover normal function of the knee only through rebuilding of single bundle anterior cruciate ligament. However, the research, made by Bergfeld and other people, shows that in clinical outcome indicators double bundle anterior cruciate ligament reconstruction(ACLR) does not present the superiority, compared with single bundle technique. And even double bundle technique has a set of disadvantages, such as higher technique difficulty, longer operation time, more spending…. Thereafter, clinicians have argued how to choose the surgical option to cure the patients with PCL injury. Those who are for single bundle technique think that it has already recovered most of the function of PCL. In addition, single bundle technique is a mature one and reliable in curative effect, so it is the first surgical choice. By contrast, the opponents consider that it is only the double bundle anterior cruciate ligament reconstruction that can totally rebuild PCL. And this technique has a better post-operative effect which is the closest to normal function of the knee.Part one: Allogeneic tendon single and double beam under arthroscopy reconstruction after cruciate ligament of the prospective cohort studyObjectiveTo study the application of prospectie cohort study of allogeneic tendon single and double beam reconstruction after cruciate ligament of the efficacy and safety.MethodsProspective registration during January 2008 to January 2013, our hospital patients with cruciate ligament damage after, were included in the standard of 42 cases of patients, according to the different operation were randomly divided into two groups, group A(n = 22 cases, using single bundle reconstruction);Group B(n = 20 cases, with double beam reconstruction).Observing two groups of patients’ hospitalization days, operation time, postoperative fever days and need to puncture the number of records after 24 months of preoperative two groups of motion, Lysholm, IKDC and Tegner score, and the results were statistically analyzed.ResultsGroup B patients surgery time and number of days in hospital were significantly higher than that of group A(P < 0.05); Lysholm B group of patients is significantly higher than group A, difference was statistically significant(P < 0.05). Motion and 24 months of two groups of patients with postoperative IKDC score and Tegner score compared with preoperative were significantly increased(P< 0.05), but the preoperative and postoperative 24 months there was no statistically significant difference between A and B two groups(P > 0.05).ConclusionSingle and double beam reconstruction under arthroscopy is safe and effective treatment for PCLS damage, but the double bundle reconstruction’s Lysholm score is higher than the single bundle reconstruction.Part 2:Single-bundle versus double-bundle posterior cruciate ligament reconstruction using tendon allografts: a meta-analysisObjectiveTo assess the clinical outcome of single-bundle versus double-bundle for posterior cruciate ligament reconstruction using tendon allografts.MethodRandomised and quasi-randomised controlled clinical trials were collected from Pubmed, Embase, The Cochrane Library, Ovid, CBM, Cnki, Wanfang, Weipu database. We also searched trial registers, conference proceedings, and contacted authors where necessary. Two review authors independently selected articles, assessed risk of bias and extracted date. Risk of bias was assessed by The Cochrane Collaboration’s toll.ResultThree RCTs involving 151 patients met the inclusion criteria Meta-analyses showed significant differences between the two operative procedures in terms of Lysholm score((MD=2.20,95%CI=0.56,3.83,P=0.008)and Knee stability measured by arthrometer. But there was no difference in range of motion, Tegner activity score, and IKDC subjective knee evaluation form between the 2 groups at Meta-analyses(P>0.05).)ConclusionThe double-bundle of posterior cruciate ligment reconstruction is superior to singlebundle reconstruction. |
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