목적: 본 연구는 이중 다발 전방십자인대 재건술 후의 단기 임상결과와 이차적 관절경 소견을 알아보았다. 대상 및 방법: 이중 다발 전방십자인대 재건술 후에 최소 24개월 이상 추시가 가능하였던 49 예(환자)를 대상으로 하였다. 임상적 결과로 Lysholm 슬관절 점수, Tegner 활동 점수, 도수 및 기계적 전방 안정성 검사를 시행하였다. 15 예에서 스테플 제거와 함께 이차적 관절경 수술을 시행하여, 재건된 전방십자인대의 파열 유무와 이식건의 주관적인 긴장 정도 및 활액막 형성 정도를 검사하였다. 결과: Lysholm 슬관절 및 Tegner 활동 점수는 각각 술전 67.4, 2.0에서 최종 추시에 96.1, 6.1로 호전되었다 (p<0.01). Lachman 및 pivot-shift 검사에서 39예, 36예가 정상범위로 호전되었다. 스트레스 방사선 검사의 양측 차이 정도는 10.8 mm 에서 3.3 mm로 의미있게 호전되었다 (p<0.01). 이차적 관절경 소견상 모든 환자에서 전내측 다발이 정상 및 정상에 가까운 소견이 관찰되었으나, 8예 (53.3%) 에서 후외측 다발의 부분 및 완전 파열이 관찰되었다. 결론: 이중 다발 전방십자인대 재건술이 임상적으로 슬관절의 회전 및 전, 후방 안정성을 복원하는 효과적인 수술법이라도, 이차적 관절경 수술을 시행한 증례의 몇 예에서 후 외측 다발의 파열이 관찰되었다.
목적: 본 연구는 이중 다발 전방십자인대 재건술 후의 단기 임상결과와 이차적 관절경 소견을 알아보았다. 대상 및 방법: 이중 다발 전방십자인대 재건술 후에 최소 24개월 이상 추시가 가능하였던 49 예(환자)를 대상으로 하였다. 임상적 결과로 Lysholm 슬관절 점수, Tegner 활동 점수, 도수 및 기계적 전방 안정성 검사를 시행하였다. 15 예에서 스테플 제거와 함께 이차적 관절경 수술을 시행하여, 재건된 전방십자인대의 파열 유무와 이식건의 주관적인 긴장 정도 및 활액막 형성 정도를 검사하였다. 결과: Lysholm 슬관절 및 Tegner 활동 점수는 각각 술전 67.4, 2.0에서 최종 추시에 96.1, 6.1로 호전되었다 (p<0.01). Lachman 및 pivot-shift 검사에서 39예, 36예가 정상범위로 호전되었다. 스트레스 방사선 검사의 양측 차이 정도는 10.8 mm 에서 3.3 mm로 의미있게 호전되었다 (p<0.01). 이차적 관절경 소견상 모든 환자에서 전내측 다발이 정상 및 정상에 가까운 소견이 관찰되었으나, 8예 (53.3%) 에서 후외측 다발의 부분 및 완전 파열이 관찰되었다. 결론: 이중 다발 전방십자인대 재건술이 임상적으로 슬관절의 회전 및 전, 후방 안정성을 복원하는 효과적인 수술법이라도, 이차적 관절경 수술을 시행한 증례의 몇 예에서 후 외측 다발의 파열이 관찰되었다.
Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction...
Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction, were included. Clinical results, such as, Lysholm knee and Tegner activity scores, and manual laxity and instrumented anterior laxity test results were evaluated. In fifteen patients (15 knees), second-look arthroscopy with staple removal was performed. At second-look arthroscopy, the authors assessed about reconstructed ACL rupture, subjective graft tension and extent of synovial coverage. Results: Lysholm knee scores significantly improved from 67.4 preoperatively to 96.1 at last follow-up (p<0.01). Tegner activity scale improved from 2.0 to 6.1. The Lachman test, at last follow-up, showed normal laxity in 39 (of 49) patients, and the pivot-shift test showed normal laxity in 36 (of 49) patients. Mean side-to-side differences improved significantly from 10.8 mm to 3.3 mm (p<0.01). Second-look arthroscopic findings showed that all patients had a normal or a near normal anteromedial bundle. However, 8 patients (53.3%) were found to have partial or complete posterolateral bundle rupture. Conclusion: Even though double-bundle ACL reconstruction was clinically effective means of restoring knee rotational and anteroposterior stabilities, there were some ruptured posterolateral bundles observed in cases under arthroscopy after double-bundle ACL reconstruction.
Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction, were included. Clinical results, such as, Lysholm knee and Tegner activity scores, and manual laxity and instrumented anterior laxity test results were evaluated. In fifteen patients (15 knees), second-look arthroscopy with staple removal was performed. At second-look arthroscopy, the authors assessed about reconstructed ACL rupture, subjective graft tension and extent of synovial coverage. Results: Lysholm knee scores significantly improved from 67.4 preoperatively to 96.1 at last follow-up (p<0.01). Tegner activity scale improved from 2.0 to 6.1. The Lachman test, at last follow-up, showed normal laxity in 39 (of 49) patients, and the pivot-shift test showed normal laxity in 36 (of 49) patients. Mean side-to-side differences improved significantly from 10.8 mm to 3.3 mm (p<0.01). Second-look arthroscopic findings showed that all patients had a normal or a near normal anteromedial bundle. However, 8 patients (53.3%) were found to have partial or complete posterolateral bundle rupture. Conclusion: Even though double-bundle ACL reconstruction was clinically effective means of restoring knee rotational and anteroposterior stabilities, there were some ruptured posterolateral bundles observed in cases under arthroscopy after double-bundle ACL reconstruction.
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가설 설정
(B) The PL bundles are not fullly covered with synovium and classified as “poor”.
We hypothesized that the anatomy of ACLs reconstructed using double bundle technique may be similarly restored to the anatomy of normal ACLs. Accordingly, we undertook this study to analyze clinical outcomes and to assess the usefulness of DB ACL reconstruction using tibialis anterior allografts by second-look arthroscopy.
제안 방법
We hypothesized that the anatomy of ACLs reconstructed using double bundle technique may be similarly restored to the anatomy of normal ACLs. Accordingly, we undertook this study to analyze clinical outcomes and to assess the usefulness of DB ACL reconstruction using tibialis anterior allografts by second-look arthroscopy.
Postoperatively, all patients wore a hinged brace that no motion limits were set. At 24 hours postoperatively, patients were placed on a rehabilitation regimen that included quadriceps muscle strengthening and straight leg raising exercises. Patients were not allowed partial weight bearing ambulation until week 8.
Patients were evaluated preoperatively and at least 2 years postoperatively. Clinical results were evaluated using ranges of motion, Lysholm knee scores, Tegner activity scores, and the Lachman and pivot-shift tests. Radiologic stabilities were evaluated by performing an instrumented laxity test using a Telos device (Telos stress device, Austin & Associates, Fallston, Maryland) at 30°of knee flexion and with a 20 lb anterior tibial load applied to the proximal tibia.
For clinical evaluations were performed using the Lachman test and the pivot-shift test, and arthrometric evaluations using the Telos device. Lysholm Knee Scores and Tegner activity scores were obtained using a self-administered questionnaire and scores were determined at the time of second-look arthroscopy and at last follow-up to assess knee functional abilities.
Radiologic stabilities were evaluated by performing an instrumented laxity test using a Telos device (Telos stress device, Austin & Associates, Fallston, Maryland) at 30 ° of knee flexion and with a 20 lb anterior tibial load applied to the proximal tibia.
The femoral AMB tunnel was prepared through an anteromedial portal at the 1:00-o’clock position for left knees or at the 11:00-o’ clock position for right knees5,9).
대상 데이터
9). The study subjects were 40 men and 9 women of average age 31.2 years at surgery (range, 14.3~58 years) (Table 1). In terms of combined meniscal injuries, 25 patients had a medial meniscal injury (13 were repaired using the inside-out technique and 12 underwent partial meniscectomy) and 9 lateral meniscal injuries (one was repaired and remaining 8 underwent partial meniscectomy).
데이터처리
The paired-samples t-test in SPSS version 17.0 was used to analyze pre- and postoperative differences (such as Tegner activity scores, Lysholm knee scores, and instrumented laxity test results). Statistical significance was accepted for p values of <0.
이론/모형
Mean age, gender, time to surgery, and mean follow-up duration were determined using medical records. For clinical evaluations were performed using the Lachman test and the pivot-shift test, and arthrometric evaluations using the Telos device. Lysholm Knee Scores and Tegner activity scores were obtained using a self-administered questionnaire and scores were determined at the time of second-look arthroscopy and at last follow-up to assess knee functional abilities.
성능/효과
In conclusion, nevertheless we had relative good clinical results and stabilities after DB ACL reconstruction, second-look arthroscopic findings showed that reconstructed DB ACL was not similarly restored to the anatomy of the normal ACL due to PLB failure.
In this series, second-look arthroscopic findings showed that the anatomy of the normal ACL was not restored due to PLB failure. Accordingly, our hypothesis that the anatomy of ACLs reconstructed using double bundle technique may be similarly restored to the anatomy of normal ACLs was not proven by the data obtained during this study.
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