Background: In this study, we determined the efficiency of anterior cruciate ligament (ACL) reconstruction using the double-bundle technique and addressed technique-specific problems. Patients and Methods: Twenty-nine...Background: In this study, we determined the efficiency of anterior cruciate ligament (ACL) reconstruction using the double-bundle technique and addressed technique-specific problems. Patients and Methods: Twenty-nine patients who underwent ACL reconstruction due to ACL rupture with the arthroscopic double-bundle ENDOBUTTON CL method using autogenous hamstring tendons were evaluated. All patients were males and the mean age was 24.3 years (range 20 - 41 years). The mean follow-up period was 36.4 months (minimum 16 and maximum 53 months). Diagnosis was based on medical history and physical examination. Lachman, anterior drawer and pivot shift tests were performed. The patient diagnosis was verified with X-ray roentgenogram and magnetic resonance imaging (MRI). Tunnel mergence and graft hanging problems were discussed. Results: Pre- and postoperative clinical assessments of the patients showed the mean Lysholm score increased from 60.2 (48 - 72) preoperatively to 91.5 (85 - 98) at the final visit, whereas the mean Tegner score increased from 5.58 (3 - 9) preoperatively to 6.03 (4 - 9) at the final visit. According to the International Knee Documentation Committee (IKDC) knee ligament standard evaluation system, five patients were classified as B (17%);11 patients were classified as C (38%);and 13 patients were classified as D (45%) before the surgery. At the postoperative evaluation, 17 (59%) patients were classified as A;11 (38%) patients were classified as B;and 1 (3%) patient was classified as C. Conclusion: The double-bundle technique using hamstring tendons and femoral braces is an efficient and satisfactory method for ACL reconstruction.展开更多
Objective To compare the difference in stability of the knee joint after single-tunnel double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Six formalin-soaked specimens of the human...Objective To compare the difference in stability of the knee joint after single-tunnel double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Six formalin-soaked specimens of the human knee with retained展开更多
Background:The achievement of an optimal return to sport(RTS)has remained a key goal after sports-related injuries,with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate li...Background:The achievement of an optimal return to sport(RTS)has remained a key goal after sports-related injuries,with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament(ACL)rupture.This study aims to assess clinical outcomes and RTS across various surgical methods,such as anatomical single-bundle reconstruction(ASBR),central-axial single-bundle reconstruction(CASBR),and double-bundle reconstruction(DBR).Methods:A randomized clinical trial was conducted,comprising 191 patients who underwent ACL rupture.These patients were divided into three groups based on the ACL reconstruction techniques they received(ASBR,CASBR,DBR).Over the 2-year follow-up period,the study assessed RTS through four single-hop tests,isokinetic extension tests,and limb asymmetry indices.Postoperative graft status was determined using the signal-to-noise quotient(SNQ),while knee function was evaluated using the International Knee Documentation Committee 2000(IKDC-2000)score,Lysholm score,Tegner score,and degree of knee laxity.A binary logistic regression model was developed to forecast the factors influencing ideal RTS.Results:DBR(67.63%)and CASBR(58.00%)exhibited higher RTS passing rates compared to ASBR(30.39%;χ^(2)=19.57,P<0.05).Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS(χ^(2)=17.08,P<0.05).The RTS rate was influenced by SNQs of the graft’s tibial site(odds ratio:0.544)and quadriceps strength of the reconstructed knee joint at 60°/s(odds ratio:6.346).Notably,the DBR group showed enhanced knee stability,evidenced by superior results in the Lachman test(χ^(2)=13.49,P<0.01),objective IKDC-2000(χ^(2)=27.02,P=0.002),and anterior instability test(χ^(2)=9.46,P<0.01).Furthermore,DBR demonstrated superior clinical outcomes based on the Lysholm score(DBR:89.57±7.72,CASBR:83.00±12.71,ASBR:83.21±11.95;F=10.452,P<0.01)and IKDC-2000 score(DBR:90.95±7.00,CASBR:84.64±12.68,ASBR:83.63±11.41;F=11.78,P<0.01).Conclusion:For patients with ACL rupture,more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups.Autograft status and quadriceps strength are postively related to RTS.展开更多
Background Several techniques have been described for posterior cruciate ligament （PCL） reconstruction. However, double-bundle PCL reconstruction using the quadruple bone-tunnel technique has been seldom reported. T...Background Several techniques have been described for posterior cruciate ligament （PCL） reconstruction. However, double-bundle PCL reconstruction using the quadruple bone-tunnel technique has been seldom reported. The current study investigated this technique, focusing on the anatomy of the femoral and tibial insertions of the anterolateral （AL） and posteromedial （PM） bundles of the PCL. Methods Twenty-two fresh, healthy adult cadaveric knees were dissected and measured. The PCL was divided into the AL bundle and PM bundle at the insertion footprint. The insertion footprints of the AL and PM bundles, their location, size, and the clock positions were measured and described. Results On the femur, the clock position of the footprint of the AL bundle was 11：21＋0：23 （left） or 0：39＋0：23 （right）, and the PM bundle was 9：50＋0：18 （left） or 2：10＋0：18 （right）, with the knee flexed at 90 degrees. The distances from the center of the femoral insertions of the AL and PM bundles to the anterior cartilage margins of the medial femoral condyle were （7.79＋1.22） mm and （8.36＋1.63） mm, respectively. On the tibia, the vertical distances from the center of the tibial insertions of the AL and PM bundles to the tibial articular surface were （3.25＋1.20） mm and （6.91＋1.57） mm, respectively. Conclusions These results have led to a better definition of the anatomy of the AL and PM bundle footprint of the PCL. The technique of double-bundle PCL reconstruction using quadruple bone-tunnel is feasible. Application of these data during PCL reconstruction using the quadruple bone-tunnel technique may help optimize knee stability.展开更多
文摘Background: In this study, we determined the efficiency of anterior cruciate ligament (ACL) reconstruction using the double-bundle technique and addressed technique-specific problems. Patients and Methods: Twenty-nine patients who underwent ACL reconstruction due to ACL rupture with the arthroscopic double-bundle ENDOBUTTON CL method using autogenous hamstring tendons were evaluated. All patients were males and the mean age was 24.3 years (range 20 - 41 years). The mean follow-up period was 36.4 months (minimum 16 and maximum 53 months). Diagnosis was based on medical history and physical examination. Lachman, anterior drawer and pivot shift tests were performed. The patient diagnosis was verified with X-ray roentgenogram and magnetic resonance imaging (MRI). Tunnel mergence and graft hanging problems were discussed. Results: Pre- and postoperative clinical assessments of the patients showed the mean Lysholm score increased from 60.2 (48 - 72) preoperatively to 91.5 (85 - 98) at the final visit, whereas the mean Tegner score increased from 5.58 (3 - 9) preoperatively to 6.03 (4 - 9) at the final visit. According to the International Knee Documentation Committee (IKDC) knee ligament standard evaluation system, five patients were classified as B (17%);11 patients were classified as C (38%);and 13 patients were classified as D (45%) before the surgery. At the postoperative evaluation, 17 (59%) patients were classified as A;11 (38%) patients were classified as B;and 1 (3%) patient was classified as C. Conclusion: The double-bundle technique using hamstring tendons and femoral braces is an efficient and satisfactory method for ACL reconstruction.
文摘Objective To compare the difference in stability of the knee joint after single-tunnel double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Six formalin-soaked specimens of the human knee with retained
基金funded by Peking University Scientific Research Fund(No.BYSYDL2021001)Beijing Natural Science Fund(No.J210011)NSFC(Nos.82302656,82002298,and 51920105006).
文摘Background:The achievement of an optimal return to sport(RTS)has remained a key goal after sports-related injuries,with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament(ACL)rupture.This study aims to assess clinical outcomes and RTS across various surgical methods,such as anatomical single-bundle reconstruction(ASBR),central-axial single-bundle reconstruction(CASBR),and double-bundle reconstruction(DBR).Methods:A randomized clinical trial was conducted,comprising 191 patients who underwent ACL rupture.These patients were divided into three groups based on the ACL reconstruction techniques they received(ASBR,CASBR,DBR).Over the 2-year follow-up period,the study assessed RTS through four single-hop tests,isokinetic extension tests,and limb asymmetry indices.Postoperative graft status was determined using the signal-to-noise quotient(SNQ),while knee function was evaluated using the International Knee Documentation Committee 2000(IKDC-2000)score,Lysholm score,Tegner score,and degree of knee laxity.A binary logistic regression model was developed to forecast the factors influencing ideal RTS.Results:DBR(67.63%)and CASBR(58.00%)exhibited higher RTS passing rates compared to ASBR(30.39%;χ^(2)=19.57,P<0.05).Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS(χ^(2)=17.08,P<0.05).The RTS rate was influenced by SNQs of the graft’s tibial site(odds ratio:0.544)and quadriceps strength of the reconstructed knee joint at 60°/s(odds ratio:6.346).Notably,the DBR group showed enhanced knee stability,evidenced by superior results in the Lachman test(χ^(2)=13.49,P<0.01),objective IKDC-2000(χ^(2)=27.02,P=0.002),and anterior instability test(χ^(2)=9.46,P<0.01).Furthermore,DBR demonstrated superior clinical outcomes based on the Lysholm score(DBR:89.57±7.72,CASBR:83.00±12.71,ASBR:83.21±11.95;F=10.452,P<0.01)and IKDC-2000 score(DBR:90.95±7.00,CASBR:84.64±12.68,ASBR:83.63±11.41;F=11.78,P<0.01).Conclusion:For patients with ACL rupture,more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups.Autograft status and quadriceps strength are postively related to RTS.
文摘Background Several techniques have been described for posterior cruciate ligament （PCL） reconstruction. However, double-bundle PCL reconstruction using the quadruple bone-tunnel technique has been seldom reported. The current study investigated this technique, focusing on the anatomy of the femoral and tibial insertions of the anterolateral （AL） and posteromedial （PM） bundles of the PCL. Methods Twenty-two fresh, healthy adult cadaveric knees were dissected and measured. The PCL was divided into the AL bundle and PM bundle at the insertion footprint. The insertion footprints of the AL and PM bundles, their location, size, and the clock positions were measured and described. Results On the femur, the clock position of the footprint of the AL bundle was 11：21＋0：23 （left） or 0：39＋0：23 （right）, and the PM bundle was 9：50＋0：18 （left） or 2：10＋0：18 （right）, with the knee flexed at 90 degrees. The distances from the center of the femoral insertions of the AL and PM bundles to the anterior cartilage margins of the medial femoral condyle were （7.79＋1.22） mm and （8.36＋1.63） mm, respectively. On the tibia, the vertical distances from the center of the tibial insertions of the AL and PM bundles to the tibial articular surface were （3.25＋1.20） mm and （6.91＋1.57） mm, respectively. Conclusions These results have led to a better definition of the anatomy of the AL and PM bundle footprint of the PCL. The technique of double-bundle PCL reconstruction using quadruple bone-tunnel is feasible. Application of these data during PCL reconstruction using the quadruple bone-tunnel technique may help optimize knee stability.
