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Title: [Mid-term effectiveness of arthroscopic anterior cruciate ligament reconstruction combined with meniscus allograft transplantation].
Author: Ding Y, Zhang Y, Jia H, Gu D, Chen L.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2019 Sep 15; 33(9):1071-1076. PubMed ID: 31512445.
Abstract:
OBJECTIVE: To summarize the mid-term effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction combined with meniscus allograft transplantation. METHODS: A clinical data of 21 patients treated with arthroscopic ACL reconstruction and meniscus allograft transplantation and followed up more than 5 years between February 2007 and December 2014 was retrospectively analyzed. There were 12 males and 9 females, aged from 18 to 45 years, with an average age of 23.5 years. The cause of injury was sport sprain in 15 cases, falling in 4 cases, and traffic accident in 2 cases. The time from injury to operation ranged from 2 to 36 months, with an average of 12 months. Among them, 15 patients underwent previous meniscectomy, with an average interval of 1.6 years (range, 3 months to 6.5 years). All patients were primary ACL reconstruction. Preoperative anterior drawer test, Lachman test, and pivot shift test were positive. Lysholm score was 43.6±10.2. International Knee Documentation Committee (IKDC) score was 60.50±14.06. Of the 21 patients, 10 were gradeⅠ-Ⅱcartilage injuries and 11 were grade Ⅲ cartilage injuries according to MRI. RESULTS: All patients were followed up 5.1-7.8 years, with an average of 5.5 years. There were 2 cases of numbness of lower extremity, 3 cases of slight exudation of incision, 2 cases of articular movement bounce, 5 cases of mild joint swelling and pain after exercise. At last follow-up, Lachman tests were negative in 18 cases and positive in 3 cases; anterior drawer tests were negative in 19 cases and positive in 2 cases; pivot shift tests were negative in all cases. Lysholm score was 84.5±16.5 and IKDC score was 85.25±4.60, which were significantly higher than those before operation ( P<0.01). The flexion and extension of the affected knee joint were (128±13) and (3±7)°, respectively, which were smaller than those of the healthy knee joint [(133±15), (0±5)°] ( P<0.01). The results of KT-1000 test showed that when knee flexion was 30 and 90°, tibial anterior displacement of affected side [(2.35±1.20), (1.60±1.15) mm] were not significantly different from those of healthy side [(1.20±1.10), (1.10±1.03) mm] ( P>0.01). MRI showed that the ACL graft was in normal position and meniscus survived well. Cartilage injuries were gradeⅠ-Ⅱ in 18 cases and grade Ⅲ in 3 cases. CONCLUSION: For patients with severe meniscus injury and ACL rupture, ACL reconstruction combined with meniscus allograft transplantation can restore the stability of the joint, recover the meniscus function which is conducive to the protection of articular cartilage and obtain satisfactory mid-term effectiveness. 目的: 总结关节镜下前交叉韧带（anterior cruciate ligament，ACL）重建联合同种异体半月板移植术治疗半月板严重损伤伴 ACL 断裂的中期疗效。. 方法: 回顾分析 2007 年 2 月—2014 年 12 月，21 例接受 ACL 重建联合同种异体半月板移植治疗并随访 5 年以上的患者临床资料。男 12 例，女 9 例；年龄 18～45 岁，平均 23.5 岁。致伤原因：运动扭伤 15 例，摔伤 4 例，交通事故伤 2 例。受伤至手术时间为 2～36 个月，平均 12 个月。其中 15 例患者既往行半月板切除术，与该次手术间隔 3 个月～6.5 年，平均 1.6 年。21 例均为初次 ACL 重建。术前前抽屉试验、Lachman 试验、轴移试验均为阳性。Lysholm 评分为（43.6±10.2）分，国际膝关节文献委员会（IKDC）评分为（60.50±14.06）分。术前 MRI 关节软骨分级：Ⅰ～Ⅱ级 10 例，Ⅲ级 11 例。. 结果: 术后患者均获随访，随访时间 5.1～7.8 年，平均 5.5 年。术后出现下肢麻木 2 例，切口轻度渗液 3 例，关节活动弹响 2 例，运动锻炼后关节轻度肿胀、疼痛 5 例。末次随访时，Lachman 试验阴性 18 例，阳性 3 例；前抽屉试验阴性 19 例，阳性 2 例；轴移试验均为阴性。Lysholm 评分为（84.5±16.5）分，IKDC 评分为（85.25±4.60）分，均明显高于术前（ P<0.01）。患侧膝关节屈曲、伸直分别达（128±13）、（3±7）°，活动范围均小于健侧（133±15）、（0±5）°（ P<0.01）。KT-1000 测试膝关节屈曲 30、90° 时患侧胫骨前移距离分别为（2.35±1.20）、（1.60 ±1.15）mm，与健侧（1.20 ±1.10）、（1.10±1.03）mm 比较，差异均无统计学意义（ P>0.01）。MRI 复查示 ACL 移植物位置正常，同种异体半月板存活良好；关节软骨分级Ⅰ～Ⅱ级 18 例，Ⅲ级 3 例。. 结论: 对于半月板严重损伤伴 ACL 断裂患者，同种异体半月板移植联合 ACL 重建能恢复关节稳定性，同时半月板功能的恢复有利于保护关节软骨，中期疗效良好。.

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