One-stage reconstructing the anterior and posterior cruciate ligaments injuries with autologous hamstring tendon using TightRope devices all inside / 中华骨科杂志

ABSTRACT

Objective To analyze the feasibility and curative effects of one-stage reconstructing the anterior and posterior cruciate ligaments injuries with autologous hamstring tendon using TightRope devices all inside.Methods Thirty-four patients who suffered from the anterior and posterior cruciate ligaments injuries referred to our center from July 2013 to July 2015.Thirty-two of them with the average age 37.4±9.2 years old (range18-61 years old),including 23 male and 9 female,were followed up over 2 years.According to the anatomy classification for knee dislocation,14 patients were KD Ⅱ type,11 patients KD Ⅲ M type,7 patients KD Ⅲ L type.The interval from injury to surgery was 4-6 weeks.One-stage reconstruction of the anterior and posterior cruciate ligaments was conducted by using autologous hamstring tendon with TightRope device all inside under arthroscopy.Ipsilateral hamstring tendon was taken in the patients of KD Ⅱ type,while opposite hamstring tendon was used in the patients of KD Ⅲ.The semitendinosus graft acted as posterior cruciate ligament,and gracilis graft acted as anterior cruciate ligament.Fold the tendon graft in half into four strands,with the length 6-7 cm,diameter 7-9 mm,and link together with two TightRope devices.The anterior and posterior cruciate ligaments injuries were reconstructed in one-stage with autologous hamstring tendon using TightRope all inside.The medial or lateral collateral ligament in patients of KD Ⅲ type was repaired.The anterior and posterior drawer test,Lachman test,valgus stress test,IKDC classification,Lysholm scores were recorded before and after surgery to evaluate the efficacy of reconstruction.Results Thirty-two patients who were treated with surgery were followed up 2-4 years with average 2.6 years.Preoperative symptoms relieved apparently in the last follow-up in all patients.The anterior and posterior drawer test and Lachman test were negative.The IKDC score of 27 patients at two years after surgery were rated as normal (84％),while that of 4 patients were rated as near normal (13％),1 patients as abnormal (3％).The rates of the normal and near normal were up to 97％.The overall score was improved from preoperation (36.4±4.6) to postoperation (90.1± 10.7,t=27.96,P=0.000).The knee function Lysholm scores was significantly increased from preoperation (52.7±5.3) to postoperation (91.5±9.2,t=23.26,P=0.000).Conclusion The one-stage reconstructing the anterior and posterior cruciate ligaments injuries with autologous hamstring tendon using TightRope devices all inside can recover the stability of knee joint with satisfied joint function postoperatively.