A follow-up arthroscopy after anterior cruciate ligament ... - J-Stage

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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