| Objective: The clinical outcomes of anterior cruciate ligament(ACL)reconstructed by peroneus longus tendon(PLT)with the length of anterior cruciate ligament stump retained ≥1/2 and <1/2 were compared,and the clinical benefits of anterior cruciate ligament stump retained with different lengths in ACL reconstruction were discussed,in order to provide evidences for the treatment of ACL stump reconstruction.Methods: A total of 62 patients treated with arthroscopic stump-preserving reconstructive surgery for anterior cruciate ligament injury of the knee joint admitted to Affiliated Hospital of Guilin Medical University from January 2017 to December 2020 were selected,retrospective study of 34 patients with unilateral ACL reconstruction in this study;patients were divided according to the length of retained stump into a group with ≥1/2 retained stump length of reconstructed ligament(N1=17)and a group with <1/2 retained stump length of reconstructed ligament(N2=17).The remaining 28 cases did not meet the inclusion criteria and were excluded.Baseline characteristics such as age,sex,right and left affected knee,body mass index(BMI),time from injury to surgery,and proportion of meniscal injuries were collected between the two groups of included patients.The proprioceptive measures-passive motor perception thresholds were analyzed preoperatively(Pre)and at 6 and 12 months(months,m)postoperatively(Po)to assess the recovery of proprioception in both groups;the International Knee Documentation Committee(IKDC)scores,Lysholm scores and Tegner activity scale were compared and analyzed before and after surgery at 6 and 12 m to assess knee function in both groups;comparative analysis of the Lachman test,anterior drawer test(ADT)and pivot shift test(PST)of the knee joint before and after surgery at 6 and 12 m to assess the stability of the knee joint between the two groups;comparing and analyzed in terms of the postoperative 12 m Single-legged Hot test and return to sport ratio to assess knee joint movement ability in the two groups.Results: Baseline characteristics data: There was no statistically significant difference between the two groups of patients in terms of age,sex ratio,left or right affected side knee ratio and BMI(P>0.05).Perioperative data: the differences in operative time,intraoperative bleeding and length of hospital stay between the two groups were not statistically significant(all P>0.05),and the differences were statistically significant when comparing the length of the stump preserved intraoperatively(group N1 compared to group N2: 67.94±12.13% compared to 32.84±6.23%,P<0.001).There was no statistically significant difference in the passive motion perception thresholds(unit:°)of Pre between the two groups(N1 group compared to N2 group:2.65±0.16 ° compared to 2.58±0.15 °,P>0.05),and the passive motion perception thresholds within each group were 1.34±0.13° and 1.13±0.11 °for Po6 and 12 m in the N1 group and 1.64±0.71° and 1.37±0.78° for Po6 and 12 m in the N2 group,respectively.The differences between Po6 m and pre within each group were statistically significant(group N1: P < 0.05,group N2:P < 0.05),Statistically significant differences between Po12 m and pre(group N1: P<0.05,group N2: P<0.05),the differences between groups at the Po6 m and Po12 m time points were statistically significant(Po6 m: P<0.001,Po12 m:P<0.001).Knee function scores: Preoperative IKDC scores(N1 group:68.12±7.79,N2 group: 67.35±5.93),Lysholm scores(N1 group: 64.95±9.59,N2group: 66.00±6.71)and Tegner scores(N1 group: 2.71±1.11,N2 group:2.88±0.93)in both groups were not statistically different from each other,and Tegner scores(N1 group: 2.71±1.11,N2 group: 2.88±0.93)were not statistically significant(P>0.05).Postoperative IKDC scores at 6 and 12 m(Group N1: Po6 m 86.12±3.06,Po12 m 91.24±2.08;Group N2: Po6 m 84.59±2.70,Po12 m92.00±2.85),Lysholm scores(Group N1: Po6 m 84.88±3.10,Po12 m92.00±2.35;Group N2: Po6 m 83.00±3.66,Po12 m 91.00±2.03)and Tegner scores(group N1: Po6 m 5.71±0.69,Po12 m 7.12±1.05;group N2: Po6 m5.24±0.90,Po12 m 7.00±0.71);the difference between Po6 m and preoperative within each group and Po12 m and Po6 m within each group was statistically significant(P<0.05);there were no statistically significant differences in IKDC scores,Lysholm scores and Tegner scores between the two groups at the Po6 m and Po12 m time points(P>0.05).Knee stability assessment: there was no statistically significant difference in Lachman score,PST score and ADT score between the two groups before surgery(P>0.05);the differences in Lachman score,PST score and ADT score at the time points of Po6 m and Po12 m between the two postoperative groups were not statistically significant(P>0.05).Knee joint motor function: there was no statistically significant difference in the Single-legged Hop test between the two groups at 12 m postoperatively(N1group compared to N2 group: 93.00±2.29% compared to 91.77±2.86%,P>0.05);however,the difference was statistically significant in the values of the percentage of complete return to exercise(N1 group compared to N2group:12/5 compared to 6/11,P<0.05).Complications: No knee infection,failure of the graft,joint stiffness,Cyclops syndrome or revision were found in either group during the 12 m post-operative follow-up period;one case of poor post-operative wound healing occurred in each group,which healed completely after debridement and suturing,with no other complications.Conclusions: In PLT reconstructed ACL with different ACL stump lengths preserved,knee function did not return to preoperative levels during the 12-month postoperative follow-up period,regardless of whether ≥1/2 or <1/2 of the ACL stump was preserved,but the ligament reconstruction treatment strategy with ≥1/2 of the stump length preserved had more significant and superior efficacy in restoring proprioceptive function and motor ability in the knee compared to the protocol with <1/2 of the stump length preserved to reconstruct the ligament length. |
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