Patellar tendon (PT) grafts have been widely used for anterior cruciate ligament (ACL) reconstruction, but varied success rates have been reported. Recently ...
JNipponMedSch1997;64(6)
18(512)
Originals
A follow-up
arthroscopy
ligament
reconstruction
tendon Yoshihito
after
augmented
Nakayama,
Yasumasa
anterior
using
the patellar
by woven Shirai,
cruciate
polyester
Tetsuya
Narita
and
Atsushi
Mori
Department of Orthopedic Surgery, Nippon Medical School
Abstract
arthroscopy,
artificial
material
The purpose copically
Introduction
augmented
Patellar
tendon (PT) grafts have been widely used
struction,
for anterior
cruciate ligament (ACL) reconstruction,
between
but varied
success
rates
have
Recently, several ligament such as woven polyester been developed ligament resulting
and
devices
weight
in acceptable
ACL reconstruction
bearing
early
surgery,
The goal of
Patient
the extent
ACL
recon-
of correlation
and functional
but
ware
few morphological
studies
on
Correspondence to Yoshihito Nakayama, Sendagi, Bunkyo-ku, Tokyo 113, Japan
and
with
Department
transplanted
of Orthopedic
1994,
test results.
Methods
These
with
grafts,
practical
Surgery,
Nippon
underwent after
examinations consent
to determine ACL
92 patients
examinations
the patients'
removal
patients
and
arthroscopic
reconstruction.
tissue,
human subiects
1987
follow-up
ligamentous
been
after
tendons
Population
Between
med
there
and to determine
arthros-
patellar
have
and functional
of damaged
with
polyester
Materials
The use of
after
outcomes.
woven
arthroscopical
devices,
may allow
is morphological
restoration have
augmentation
in ACL reconstruction.
by
grafts
reported.
and polypropylene,
augmentation
mobilization
been
of this study was to evaluate
composite
were
at the time the and
guidelines Medical
ACL perforof hard-
condition to for
of the
provide
the
subsequent
School,
1-1-5
(513)19
physical and sporting activity. There were 52 males and 40 females
Arthroscopical
examined
The
mean
with a mean age of 24.6 years (range: 14-57 years).
copy
ranged
Seventy-two
13.1
months.
tions
were
of the patients
51 had meniscal ligament
had associated
injuries:
tears, and 24 had medial collateral
injuries.
atively,
Surgical procedure One-third
and rehabilitation
of PT with bone blocks
was harvested,
on both ends
and tubed with absorbable
(Fig. 1). Woven polyester device) was sutured composite
prograins
(Leeds-Keio augmentation
tightly around
graft with a diameter
was passed through
sutures
PT to make a
of 8 mm. The graft
the tibial and femoral
and fixed to the femur with 2 staples,
tunnels.
and to the
tibia with a screw.
more
sified
into
day, ROM exercises
on
was allowed full weight exercises
2 weeks after bearing
at 8 weeks.
were started
muscle exercises
surgery,
increasing
Isotonic
to
muscle
at 2 weeks, and isokinetic
with ARIEL-CES
(180 deg/sec)
at
4 weeks.
24
ligamentous
to
were
and
gradeIII,
taut
thin
thick
and
but
from
and
clas
tissue
loose
some
the
synovial
ligamentous
tissue
observed,
as
knee
function
was
2
arthroscopical
observed,
exposed thick
synovial
the
and
ligamentous
grade II,
observed;
of
postoper
months,
patients
1,
tissue
mean examina
24
The
observed;
grade IV,
arthros
a
12 months and
grade
strands
a
than
according
tissue
ligamentous
(Fig.
less
months.
ligamentous
with
arthroscopical
follows: not
and
months,
12 months
4 grades
or
tissue;
surgery
26
out
than
ruptured
the CPM device were begun. Partial weight bearing
to
between
as
taut
6
Twenty-two
findings
cvalnalions
between
from
carried
after
functional
interval
68
with
On the third postoperative
and
in
tissue
normal
ACL
2).
Postoperative KT-1000
arthrometer
knee
laxity,
thigh
range
of
with
90
N
med
by
variance
was
of
as
chi
the
20
knee
analysis square
minimum
loss
of
arthrometer
at
Statistical and
by anterior
and
KT-1000
performed
force.
accepted
(ROM)
The
was
for
motion
circumference.
measurement
evaluated
measurement
flexion
was
tests, level
perfor
and of
p-0.05
significance.
Results
Based
on
patients
the
arthroscopical
(4.3%)
grade II,
24
were
The
copical
as
and
Postoperative
Surgical
technique
of composite
graft
forma
a. One locks,
of the
b. Woven
patellar
tendon,
patellar
tendon
patellar
polyester c.
tendon is sutured
Composite
and woven
graft
polyester
with
in
(range:
had
a difference
92
(12.0%)
as
53
(57.6`%)
as
the
surgery
arthros-
is shown
and
2
anterior
in
of
5
10•K.
3.7•K ; 6 patients
one
The
patients
mean
(94.6%) of
thigh
to
had
mm.
1.8 •}
a
circumference
patients
The 4
mean
knee a was
of
10•K, and
4.5,
motion.
5
had
flexion
148.4•}
was
3 to
patients
limitation
range
1.7
patients
knee
was
full
12
, and
mean
ROM had
less,
7
1.9
The
was
Seventy-eight or
±
148.9•} 20•K.
laxity
3 mm
0.4
measure-
injured-to-uninjured
6 nun).
patients
limitation
mean knee
to of
was
arthrometer
the
-2.6
extension
loss
third
that
mm
mm,
tion
after
the
I, 11 and
between
time
KT-1000
showed
difference
I
grade
4 of
1.
ments
Fig.
as
grade III,
relationship
findings
Table
rated
(26.1%)
grade IV.
findings,
and
The
1.2 •}
87
mean 1.0
cm
boneb
around with
the the
(range:
0 to
obtained Correlation
in
5 cm), 47
of
and the
between
a
loss
patients
of (51.1
arthroscopical
1 cm
or
less
was
%). and
func
20 (514)
gradeII
gradeI
gradeIII Fig. 2 Arthroscopical
evaluation
Arthroscopical
results
were
grade
ligamentous
observed,
tissue
IV: thick
Arthroscopical ACL
and taut
results
and
after
classified
ed or not observed;
grade
gradeIV
of grafts II: loose
into
4 grades
and thin
but
some
ligamentous
time
reconstruction as follows.
ligamentous
ligamentous
tissue
with
after
grade
tissue strands
tissue
3
from
results,
and taut
synovial
tissue;
as in normal
between ROM,
ruputur
III: thick the
observed,
Correlation
reconstruction
tissue
grade
exposed
a synovial
Table
I: ligamentous
observed;
ACL
arthroscopical
and loss of thigh
circumfer
ence
No
Correlation
between
correlation
copical
results
and
post-operative
was
demonstrated
between
arthros
arthroscopical results,
ROM,
and
loss
of
thigh
circumfer-
KT-1000 ence.
measutrment
tional
test
results
was
injured-to-uninjured laxity
were
2.4 •} in
1.7 the
grade uninjured
3.9 •} mm
grade IV
investigated,
and
differences
in III
group differences
0.9 the
in
mm
grade
group,
in II
and
(Table
2). in
anterior
the
group,
I
2.2 •} 1.6 mean knee
mean knee
grade
1.3 •} The
the
anterior
group, 1.9
nun
mm in
the
injured-tolaxity
were,
(515)21
therefore,
significantly
smaller
in the
grade
IV
operatively
obtained
group than in the grade I and grade II groups (p< 0.05). Moreover, the percentage of cases with a
that
difference
this period.
of 3 mm or less was 0 % in the grade I
composite
polyester
grade III group, and 92.4% in the grade IV group, with significant differences between the groups (p
