膝关节前交叉韧带损伤重建: ACL个体化必要or不必要？

2018年08月01日 4584人阅读返回文章列表

20150118江苏高绪仁膝肩关节尖端手术国际临床经验SCI论文研读会

Dr. Xuren GAO knee & Shoulder Journal Club

本期主题：膝关节前交叉韧带损伤重建: ACL个体化必要or 不必要？

徐州医科大学附属医院骨科高绪仁

2015年1月18日，江苏徐州高绪仁膝肩关节镜手术团队在徐州医学院附属医院（徐医附院、徐州二院）新病房大楼九楼北区骨科医生办公室进行了20150118高绪仁膝肩关节尖端手术国际临床经验SCI论文研读会(Dr. Xuren GAO knee & Shoulder Journal Club)。

本次研讨的论文题目是：

1.The concept of individualized anatomic anterior cruciate ligament

(ACL) reconstruction

2.Individualized Anatomic Anterior Cruciate Ligament Reconstruction.

3.Individualized Anterior Cruciate Ligament Surgery A Prospective Study Comparing Anatomic Single- and Double-Bundle Reconstruction

通过此次高绪仁膝肩关节尖端手术国际临床经验SCI论文研读会(Dr.Xuren GAO knee & Shoulder Journal Club)，高绪仁膝肩关节镜手术团队的成员进一步加强了对膝关节镜下前交叉韧带损伤个性哈重建的理解，对于指导高绪仁膝肩关节镜手术团队进一步开展膝关节镜下前交叉韧带损伤个性化重建技术的相关诊断、治疗、科研进一步打下了良好的基础。对更好地为江苏省徐州市及周边1000万医疗人口的膝关节前交叉韧带损伤、膝关节后交叉韧带损伤、膝关节半月板损伤、膝关节前交叉韧带胫骨结节撕脱骨折、膝关节后交叉韧带胫骨结节撕脱骨折、膝关节内侧副韧带损伤、膝关节后外侧角损伤、膝关节多发韧带损伤、膝关节髌骨不稳、膝关节滑膜疾病提供中国乃至世界第一流的膝关节镜微创手术服务更进一步打下了基础。

原文链接：

1 http://www.ncbi.nlm.nih.gov/pubmed/23740328

Knee Surg Sports Traumatol Arthrosc. 2014 May;22(5):979-86. doi: 10.1007/s00167-013-2562-4. Epub 2013 Jun 6.

The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction.

Hofbauer M1, Muller B, Murawski CD, van Eck CF, Fu FH.

Author information

Abstract

PURPOSE:

To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction.

METHODS:

The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL reconstruction. Surgical experiences with case examples are also highlighted.

RESULTS:

Individualized ACL surgery allows for the customization of surgery to each individual patient. Accounting for graft selection and other characteristics such as anatomy, lifestyle and activity preferences may provide the patient with the best potential for a successful outcome. The surgeon should be comfortable with a variety of graft harvests and surgical techniques when practicingindividualized surgery.

CONCLUSION:

Individualized anatomic ACL reconstruction is founded on the objective evaluation of functional anatomy and individual characteristics, thereby restoring the ACL as closely as possible to the native anatomy and function. The adoption and subsequent use of individualized surgery may facilitate improved clinical as well as objective outcomes, particularly in the long term.

LEVEL OF EVIDENCE:

2 http://www.ncbi.nlm.nih.gov/pubmed/23766970

Arthrosc Tech. 2012 Mar 3;1(1):e23-9. doi: 10.1016/j.eats.2011.12.004. Print 2012 Sep.

Individualized anatomic anterior cruciate ligament reconstruction.

Rabuck SJ1, Middleton KK, Maeda S, Fujimaki Y, Muller B, Araujo PH, Fu FH.

Author information

Abstract

Arthroscopic anterior cruciate ligament reconstruction (ACL-R) is a technique that continues to evolve. Good results have been established with respect to reducing anteroposterior laxity. However, these results have come into question because nonanatomic techniques have been ineffective at restoring knee kinematics and raised concerns that abnormal kinematics may impact long-term knee health. Anatomic ACL-R attempts to closely reproduce the patient's individualanatomic characteristics. Measurements of the patient's anatomy help determine graft choice and whether anatomicreconstruction should be performed with a single- or double-bundle technique. The bony landmarks and insertions of theanterior cruciate ligament (ACL) are preserved to assist with anatomic placement of both tibial and femoral tunnels. Ananatomic single- or double-bundlereconstruction is performed with a goal of reproducing the characteristics of the native ACL. Long-term outcomes for anatomicACL reconstruction are unknown. By individualizing ACL-R, we strive to reproduce the patient's native anatomy and restore knee kinematics to improve patient outcomes.

Am J Sports Med. 2012 Aug;40(8):1781-8. doi: 10.1177/0363546512446928. Epub 2012 May 16.

Individualized anterior cruciate ligament surgery: a prospective study comparinganatomic single- and double-bundle reconstruction.

Hussein M1, van Eck CF, Cretnik A, Dinevski D, Fu FH.

Author information

Abstract

BACKGROUND:

Reconstruction of the anterior cruciate ligament (ACL) has become a commonly performed procedure. However, biomechanical studies have demonstrated that conventional single-bundle ACL reconstruction techniques are only successful in limiting anteriortibial translation but less effective for restoring rotatory laxity.

PURPOSE:

This study aimed to compare the results of single- and double-bundle ACL reconstruction using an anatomictechnique,individualized based on the patient's native ACL size. The authors hypothesized that there would be no difference between the results of anatomic single-bundle (ASB) and anatomic double-bundle (ADB) reconstruction when the surgical technique isindividualized.

STUDY DESIGN:

Cohort study; Level of evidence, 2.

METHODS:

Depending on intraoperative measurements of the ACL insertion site size, patients were selected for either ASB (n = 32) or ADB (n = 69) ACL reconstruction. In all groups, hamstring tendons autograft was used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score, subjective International Knee Documentation Committee (IKDC) form, KT-1000 arthrometer for anteroposterior stability, and pivot-shift test for rotational stability. The average follow-up was 30 months (range, 26-34 months). There were no statistically significant differences in the baseline demographics of the 2 groups.

RESULTS:

There was no significant difference between the ADB and ASB groups for Lysholm score (93.9 vs 93.5), subjective IKDC score (93.3 vs 93.1), anterior tibial translation (1.5- vs 1.6-mm side-to-side difference), and pivot shift (92% vs 90% with negative pivot-shift examination).

CONCLUSION:

Anatomic double-bundle reconstruction is not superior to anatomic single-bundle reconstruction when an individualized ACLreconstruction technique is used.

上图：江苏徐州高绪仁膝肩关节镜手术团队在徐州医学院附属医院（徐医附院、徐州二院）新病房大楼九楼北区骨科医生办公室进行20150118高绪仁膝肩关节镜手术国际临床经验SCI论文研读会(Dr. Xuren GAO knee & Shoulder Journal Club)。