Clinical observation of functional eccentric interference screw fixation for reconstruction of anterior cruciate ligament / 中华骨科杂志

ABSTRACT

Objective To investigate the early stage clinical outcomes of reconstruction of the anterior cruciate ligament with functional eccentric fixation. Methods We retrospective reviewed the 35 patients with anterior cruciate ligament reconstruc?tion from autologous hamstring tendon from April 2015 to March 2017. The humeral were fixed with interference screws and divid?ed into two groups according to different fixation methods. The group I was fixed with functional eccentric interference screw, in?cluding a total of 16 cases (9 males and 7 females, mean age 26.8 years). The group II was fixed with anatomical foot print central fixation screw, including a total of 19 cases (11 males and 8 female, mean age 27.6 years). Lysholm scores were recorded before and 1 year postoperatively in group I and group II. Gait analysis of knee flexion and extension, varus and valgus, internal and exter?nal rotation angle, and the MRI was performed at 1 year after surgery to observe the clinical effects. Results The Lysholm score of the functional eccentric fixed group increased from preoperative 58.5±5.5 points to 87.5±4.5 points with statistically significant difference (t=18.532, P=0.014). The foot print central fixed group increased from preoperative 57.0±6.5 points to 89.0±5.0 points with statistically significant difference (t=19.213, P=0.012). There was no significant difference between the eccentric fixed group and the foot print central fixed group in postoperative function (t=0.968, P=0.067). In gait analysis, the maximum flexion angle of the knee joint was increased from 51.8°±4.5°to 61.4°±3.5°before operation in functional eccentric group (t=8.532, P<0.001). The average mid?standing angle in eccentricity group (3.8°±2.1°) was lower than that in the foot center group (8.5°±2.8°) (t=8.716, P<0.001). There was no significant difference in the angle of internal and external valgus between the functional eccentricity group (8.6°±5.8°) and the fixed position of the foot print group (5.4°±5.2°) (t=0.382, P=0.844). The average mid?standing external rota? tion angle of the functional eccentric group was reduced from preoperative 10.5°±6.8°to postoperative-2.3°±4.1°(t=7.987, P<0.001). There was no significant difference in the average mid?standing external rotation angle of the standing phase in the postop?erative functional eccentricity group (-2.3°±4.1°) comparing with that of the foot center group (-2.1°±4.8°) (t=0.628, P=0.581). Conclusion Arthroscopic reconstruction of ACL with functional eccentric can effectively restore the function and kinematic char?acteristics of the knee joint.