ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH SIX STRANDS OF HAMSTRING TENDONS ENVELOPED Y PERIOSTEUM_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Mingxin ¹ , LIU Yujie ² , SONG Likun ¹ , ZHU Juanli ² , QI Wei ² , WANG Ning ²

1Department of Orthopedics, General Hospital of Armed Police Forces, Beijing, 100039, P.R.China;;
2Department of Orthopedics, General Hospital of Chinese PLA;

Corresponding author：

Keywords：

Knee joint; Anterior cruciate ligament injury; Arthroscopy; Hamstring tendon; Ligament reconstruction

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Objective To evaluate the feasibility of the anterior cruciate ligament (ACL) reconstruction with 6 strands of hamstring tendons enveloped by periosteum. Methods Between April 2008 and April 2009, 34 patients with ACL injury were treated, ACL of whom was reconstructed with 6 strands of hamstring tendons enveloping of periosteum and double Rigidfix fixation. There were 30 males and 4 females, aged 19-54 years with an average of 29.4 years. The causes of injury included sport in 19 cases, traffic accident in 8 cases, falling from height in 5 cases, and other in 2 cases. The locations were left knee in 19 cases and right knee in 15 cases. The disease duration was 3 weeks to 18 months (median, 9.4 months). The results of Lachman test and anterior drawer test were positive. The Lysholm knee score was 61.5 ± 3.6. MRI examination revealed ACL rupture in 26 cases and ACL injury in 8 cases. Results All incisions healed by first intention, and no early complication occurred. Twenty-eight cases were followed up 12-32 months (mean, 16.1 months). The result of Lachman test was negative at 12 months after operation; in all patients, knee extension reached 0°, and flexion reached 120-150° (mean, 132.5°). The AP and lateral X-ray films and MRI showed no bone tunnel expansion. At last follow-up the therapeutic effect evaluation was excellent in 25 cases, good in 1 case, and fair in 2 cases; the excellent and good rate was 92.9%. The postoperative Lysholm score was 91.0 ± 3.2, showing significant difference when compared with preoperative score (t=32.78, P=0.00). Conclusion Six strands of hamstring tendons can ensure sufficient tensile strength, and use of the double Rigidfix absorbable screw makes fixation more reliable. Facing outside suture of periosteal flap can promote tendon-bone healing, so it is a good method of ACL reconstruction.

Citation： WANG Mingxin,LIU Yujie,SONG Likun,ZHU Juanli,QI Wei,WANG Ning. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH SIX STRANDS OF HAMSTRING TENDONS ENVELOPED Y PERIOSTEUM. Chinese Journal of Reparative and Reconstructive Surgery, 2011, 25(4): 389-392. doi: Copy

1.	王亦璁. 膝关节韧带损伤的评估. 中华骨科杂志, 1997, 17(8): 536.
2.	Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg (Am), 1980, 62(2): 259-270.
3.	Bartlett RJ, Clatworthy MG, Nguyen TN. Graft selection in reconstruction of the anterior cruciate ligament. J Bone Joint Surg (Br), 2001, 83(5): 625-634.
4.	Lawhorn KW, Howell SM. Principles for using hamstring tendons for anterior cruciate ligament reconstruction. Clin Sports Med, 2007, 26(4): 567-585.
5.	Tom JA, Rodeo SA. Soft tissue allografts for knee reconstruction in sports medicine. Clin Orthop Relat Res, 2002, (402): 135-136.
6.	Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Am J Sports Med, 1991, 19(5): 478-484.
7.	赵金忠, 何耀华, 王建华. 关节镜下采用四股和八股腘绳肌肌腱双束重建前十字韧带的比较研究. 中华骨科杂志, 2006, 26(6): 381-385.
8.	赵金忠. 膝关节重建外科学. 郑州: 河南科学技术出版社, 2007: 4.
9.	Ma CB, Keifa E, Dunn W, et al. Can pre-operative measures predict quadruple hamstring graft diameter? Knee, 2010, 17(1): 81-83.
10.	Limitlaohaphan C, Kijkunasatian C, Saitongdee P. Length of semitendinosus and gracilis tendons and the relationship of graft length and leg length. J Med Assoc Thai, 2009, 92 Suppl 6: S200-203.
11.	Chen CH, Chen WJ, Shih CH. Enveloping of periosteum on the hamstring tendon graft in anterior cruciate ligament reconstruction. Arthroscopy, 2002, 18(5): 27E.
12.	Chen CH, Chang CH, Su CI, et al. Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy, 2010, 26(7): 907-917.
13.	白正武, 朱本珂, 张明, 等. 移植物不同固定方式对自体腘绳肌腱重建膝前交叉韧带术后股骨骨道影响的对比研究. 中国矫形外科杂志, 2010, 18(2): 106-109.
14.	刘玉杰, 李海峰, 王俊良, 等. 国人腘绳肌腱移植不同固定方式重建ACL的生物力学研究. 中国矫形外科杂志, 2010, 18(4): 297-299.
15.	李中正, 王林, 赵捷, 等. 关节镜下Rigidfix与Intrafix固定腘绳肌腱重建前交叉韧带的临床研究. 现代实用医学, 2010, 22(6): 698-699.
16.	Price R, Stoney J, Brown G. Prospective randomized comparison of endobutton versus cross-pin femoral fixation in hamstring anterior cruciate ligament reconstruction with 2-year follow-up. ANZ J Surg, 2010, 80(3): 162-165.

1. 王亦璁. 膝关节韧带损伤的评估. 中华骨科杂志, 1997, 17(8): 536.
2. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg (Am), 1980, 62(2): 259-270.
3. Bartlett RJ, Clatworthy MG, Nguyen TN. Graft selection in reconstruction of the anterior cruciate ligament. J Bone Joint Surg (Br), 2001, 83(5): 625-634.
4. Lawhorn KW, Howell SM. Principles for using hamstring tendons for anterior cruciate ligament reconstruction. Clin Sports Med, 2007, 26(4): 567-585.
5. Tom JA, Rodeo SA. Soft tissue allografts for knee reconstruction in sports medicine. Clin Orthop Relat Res, 2002, (402): 135-136.
6. Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Am J Sports Med, 1991, 19(5): 478-484.
7. 赵金忠, 何耀华, 王建华. 关节镜下采用四股和八股腘绳肌肌腱双束重建前十字韧带的比较研究. 中华骨科杂志, 2006, 26(6): 381-385.
8. 赵金忠. 膝关节重建外科学. 郑州: 河南科学技术出版社, 2007: 4.
9. Ma CB, Keifa E, Dunn W, et al. Can pre-operative measures predict quadruple hamstring graft diameter? Knee, 2010, 17(1): 81-83.
10. Limitlaohaphan C, Kijkunasatian C, Saitongdee P. Length of semitendinosus and gracilis tendons and the relationship of graft length and leg length. J Med Assoc Thai, 2009, 92 Suppl 6: S200-203.
11. Chen CH, Chen WJ, Shih CH. Enveloping of periosteum on the hamstring tendon graft in anterior cruciate ligament reconstruction. Arthroscopy, 2002, 18(5): 27E.
12. Chen CH, Chang CH, Su CI, et al. Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy, 2010, 26(7): 907-917.
13. 白正武, 朱本珂, 张明, 等. 移植物不同固定方式对自体腘绳肌腱重建膝前交叉韧带术后股骨骨道影响的对比研究. 中国矫形外科杂志, 2010, 18(2): 106-109.
14. 刘玉杰, 李海峰, 王俊良, 等. 国人腘绳肌腱移植不同固定方式重建ACL的生物力学研究. 中国矫形外科杂志, 2010, 18(4): 297-299.
15. 李中正, 王林, 赵捷, 等. 关节镜下Rigidfix与Intrafix固定腘绳肌腱重建前交叉韧带的临床研究. 现代实用医学, 2010, 22(6): 698-699.
16. Price R, Stoney J, Brown G. Prospective randomized comparison of endobutton versus cross-pin femoral fixation in hamstring anterior cruciate ligament reconstruction with 2-year follow-up. ANZ J Surg, 2010, 80(3): 162-165.

Chinese Journal of Reparative and Reconstructive Surgery

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH SIX STRANDS OF HAMSTRING TENDONS ENVELOPED Y PERIOSTEUM

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