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 (range:18-61 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.%目的 分析采用膝关节镜全内技术自体腘绳肌腱移植一期重建前、后十字韧带断裂的可行性及疗效.方法 2013年7月至2015年7月收治前、后十字韧带同时断裂患者34例,采用膝关节镜全内技术自体腘绳肌腱移植一期重建,术后获得2年以上随访者32例.男23例,女9例;年龄(37.4±9.2)岁(范围18～61岁).按膝关节脱位的解剖分类:KDⅡ型14例,KDⅢM型11例,KDⅢL型7例.外伤至手术时间为4～6周.KIDⅡ型取同侧腘绳肌腱,KDⅢ型取对侧腘绳肌腱;半腱肌肌腱作为后十字韧带移植物,股薄肌肌腱作为前十字韧带移植物.半腱肌肌腱或股薄肌肌腱对折成四股,与可调节锁扣带袢钛板相连,移植物长度约6～7 cm,直径约7～9 mm.对KDⅢ型依次修复或重建内侧或外侧副韧带.根据重建手术前后膝关节前、后抽屉试验,Lachman试验,内、外翻应力试验,国际膝关节文献委员会(International Knee Documen-tation Committee,IKDC)膝关节功能评估表及Lysholm评分对疗效进行评估.结果 随访2～4年,平均2.6年.末次随访时患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善,前、后抽屉试验均为阴性,Lachman试验阴性.术后2年膝关节IKDC评分正常者27例(84％),接近正常者4例(13％),异常者1例(3％);IKDC主观膝关节评估表评分由术前(36.4±4.6)分提高至(90.1±10.7)分,手术前后差异有统计学意义(t=27.96,P=0.000);Lysholm评分由术前(52.7±5.3)分提高至(91.2±9.2)分,手术前后差异有统计学意义(t=23.26,P=0.000).结论 采用膝关节镜全内技术自体腘绳肌腱移植一期重建膝关节前、后十字韧带断裂,能有效恢复膝关节的稳定性,术后早期膝关节功能良好.
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