Résumé
OBJECTIVE: structure and biomechanics studies of posterior cruciate ligament (PCL) demonstrated that double-bundle hamstring graft has similar function to healthy PCL. semitendinosus and gracilis can stabilize knee joint by preventing anterior tibial displacement. Therefore, the aim of this paper is to evaluate the efficacy of construction a PCL using semitendinosus and gracilis bundles.METHODS: Nine patients who were underwent double bundle PCL reconstruction from March 2006 to December 2007, and received a more than 18 months follow-up, were collected, including 8 males and 1 female, aged 21-42 years. Four patients were suffered simple PCL injury,and the other 5 patients combined with meniscus injury. Two tunnels of 5 mm diameter was made in the femoral attachment site of PCL, one tunnel of 8.0 mm diameter was made in the tibial attachment site of PCL. The anterior bundle was reconstructed using semitendinosus tendon, and the posterior bundle was reconstructed using the gracilis tendon. We reserved the attachment of the semitendinosus and gracilis tendon outside of tibial tunnel, and tied a knot using tendens outside of femoral tunnels. No internal fixation was needed. Posterior drawer test was performed in 30.60 and 90 degrees of flexion of the knee joint, and Lysholm rating system was used to determine the function of the knee and the patient's level of activity. RESULTS: Nine patients were included in the final analysis. Prior to operation, posterior drawer test in 30, 60 and 90 degrees of flexion was positive in all 9 cases. However, at 18 months after operation, posterior drawer test in 30, 60 and 90 degrees was negative in 8 cases, only 1 patient had positive posterior drawer test in 30 degrees. The mean Lysholm score was 55 points (45-68points) prior to operation, which was 88 points (78-94 points) postoperatively. The excellent and good results were obtained in 89%.CONCLUSION: Double bundle reconstruction of the PCL mimics more closely to the natural behavior of the normal PCL, which can restore normal knee laxity across the full range of motion. However, the cases were limited, so the prostecdtive efficacy needs to be followed up.
Résumé
Objective The investigation was to evaluate the method and the efficacy of double-bun-dle anterior cruciate ligament reconstruction with semitendinosus and gracilis tendon through two bone tun-nels.Methods From April1998to May2000,12patients underwent double-bundle anterior cruciate liga-ment reconstruction were reviewed and followed up more than18months.There were12male and2female patients aging from17to38years old(mean,25.5years).5cases were associated with simple anterior cru-ciate ligament injury,and the other7cases suffered from anterior cruciate ligament injury with concomitant torn meniscus.Two bone tunnels of4.5mm diameter were made in the tibial and the femoral attachment site of ACL anteromedial bundle and posterolateral bundle respectively.The anteromedial bundle was recon-structed using semitendinosus tendon,and the posterolateral bundle was reconstructed using the gracilis ten-don.The attachments of the semitendinosus and gracilis tendon outside tibial tunnels were reserved,the re-paired tendons were tied as a knot outside femoral tunnels.There was not need to do any internal fixation.Anterior drawer test was performed in30,60and90degrees of flexion of the knee joint,and Lysholm rating system was used to determine the function of the knee and the level of activity of the patients.Results Be-fore operation,anterior drawer test in30,60and90degrees of flexion of the knee joint was positive in all patients,the mean Lysholm scores were50.5points(range,40to58points).18months after operation,ante-rior drawer test in30,60and90degrees was negative in9cases,anterior drawer test in60,90degrees of flexion of the knee joint was negative in2cases,in90degrees negative in1case;The mean Lysholm scores was85points(range,62to92points).The good and excellent results were obtained in91.7%.Conclusion The combination of double-bundle anterior cruciate ligament reconstruction makes a great progress to anatomic reconstruction,provides better dynamic stability of the knee joint,and predisposes the patients sat-isfactory clinical effects.