Revision anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendons and lateral extra-articular reconstruction

被引:63
作者
Ferretti, Andrea
Conteduca, Fabio
Monaco, Edoardo
De Carli, Angelo
D'Arrigo, Carmelo
机构
[1] Univ Roma La Sapienza, St Andrea Hosp, Orthopaed Unit, I-00179 Rome, Italy
[2] Univ Roma La Sapienza, St Andrea Hosp, Kirk Kilgour Sports Injury Ctr, I-00179 Rome, Italy
关键词
D O I
10.2106/JBJS.F.00064
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: The outcome of revision anterior cruciate ligament reconstruction has only rarely been reported. The purpose of this study was to evaluate the results of revision anterior cruciate ligament surgery with use of an autogenous doubled semitendinosus and gracilis graft in association with an extra-articular procedure. Methods: Between 1997 and 2003, thirty patients underwent a repeat reconstruction of a previously reconstructed torn anterior cruciate ligament with use of a doubled semitendinosus and gracilis graft combined with an extra-articular reconstruction. Primary reconstruction had been done with an autogenous patellar tendon graft in twenty-six patients and with a prosthetic ligament in four patients; the average time from the primary reconstruction to the revision was five years. Functional outcomes, graft survival, and radiographic outcomes were evaluated at a mean of five years. A graft was considered to have failed when a revision was done or when the side-to-side difference on KT-1000 arthrometer testing was >5 mm and/or the pivot-shift test grade was greater than a trace. Results: One patient underwent another revision reconstruction because of graft failure at three years postoperatively. The mean International Knee Documentation Committee (IKDC) subjective knee score for the remaining twenty-nine patients was 84 +/- 12 points, and the mean Lysholm knee score was 90 +/- 10 points. The side-to-side difference as measured with the KT-1000 arthrometer with maximum manual force was <3 mm in twenty patients (of the twenty-eight who returned for follow-up), between 3 and 5 mm in six patients, and >5 mm in two patients. The result of the pivot shift examination was normal in fifteen patients, slightly positive in eleven patients, and positive in two patients. Twenty-five percent of the patients showed no radiographic signs of degenerative joint disease. Conclusions: Revision anterior cruciate ligament reconstruction with use of an autogenous doubled semitendinosus and gracilis graft combined with an extra-articular procedure provided satisfactory functional outcomes, with a failure rate of 10%. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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页码:2373 / 2379
页数:7
相关论文
共 32 条
[1]
Anderson AF., KNEE SURG, V1994, P275
[2]
Barrett G R, 1995, Am J Knee Surg, V8, P1
[3]
Brown CH, 2001, EUR J SPORT TRAUMA R, V23, P69
[4]
AN INVITRO STUDY OF AN INTRAARTICULAR AND EXTRAARTICULAR RECONSTRUCTION IN THE ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEE [J].
DRAGANICH, LF ;
REIDER, B ;
LING, M ;
SAMUELSON, M .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1990, 18 (03) :262-266
[5]
KNEE JOINT CHANGES AFTER MENISCECTOMY [J].
FAIRBANK, TJ .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 1948, 30 (04) :664-670
[6]
Evolgate fixation of doubled flexor graft in anterior cruciate ligament reconstruction - Biomechanical evaluation with cyclic loading [J].
Ferretti, A ;
Conteduca, F ;
Labianca, L ;
Monaco, E ;
De Carli, A .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2005, 33 (04) :574-582
[7]
The evolgate: A method to improve the pullout strength of interference screws in tibial fixation of anterior cruciate ligament reconstruction with doubled gracilis and semitendinosus tendons [J].
Ferretti, A ;
Conteduca, F ;
Morelli, F ;
Ticca, L ;
Monaco, E .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2003, 19 (09) :936-940
[8]
FERRETTI A, 1989, Italian Journal of Orthopaedics and Traumatology, V15, P415
[9]
FERRETTI A, 1997, ITAL J ORTHOP TRAUMA, V23, P433
[10]
Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft [J].
Fox, JA ;
Pierce, M ;
Bojchuk, J ;
Hayden, J ;
Bush-Joseph, CA ;
Bach, BR .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2004, 20 (08) :787-794