OBJECTIVE: To investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope.
METHODS: Between June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the
trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups ( P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation.
RESULTS: The operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the
trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups ( P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months ( P<0.05); the scores in the trial group were significantly better than those of the control group ( P<0.05). At 12 months after operation, the difference of the posterior relaxation of the bilateral knees in the
trial group was less than 5 mm in 27 cases, 6-10 mm in 2 cases; in the control group was less than 5 mm in 20 cases, 6-10 mm in 6 cases, and >10 mm in 3 cases; the difference between the two groups was not significant ( Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the
trial group was better than that of the control group ( t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the
trial group were significantly better than those in the control group ( P<0.05).
CONCLUSIONS: PRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.
UNASSIGNED: 探讨关节镜下富血小板血浆(platelet rich plasma,PRP)辅助 3 股腓骨长肌腱重建后交叉韧带(posterior cruciate ligament,PCL)的临床疗效。.
UNASSIGNED: 2014 年 6 月—2017 年 12 月选择符合标准的 58 例 PCL 断裂患者,按随机数字表法,随机分为试验组(应用 PRP 辅助 3 股腓骨长肌腱重建)和对照组(单纯 4 股腘绳肌腱重建),每组 29 例。两组患者性别、年龄、受伤侧别、Kellgren-Lawrence 分级、受伤至手术时间及术前美国矫形足踝协会(AOFAS)踝-后足评分、国际膝关节文献委员会(IKDC)评分、Lysholm 评分等一般资料比较差异均无统计学意义( P>0.05)。术前和术后 3、12 个月两组采用 IKDC 评分及 Lysholm 评分评估膝关节功能,采用 AOFAS 踝-后足评分评估足踝部功能;术后 12 个月,应用 KT-2000 检查(屈膝 90°,30 磅)评估双侧膝关节后向松弛度差异,行 MRI 检查评估韧带重建情况;术后 3、12 个月行 CT 检查评估股骨及胫骨骨隧道内口的扩大程度。.
UNASSIGNED: 两组手术均顺利完成,供腱区均无并发症发生,手术切口均 Ⅰ 期愈合。患者均获 1 年以上随访,试验组随访时间 13~17 个月,平均 15.0 个月;对照组 15~20 个月,平均 15.4 个月。术后 3、12 个月,两组 AOFAS 踝-后足评分与术前比较,以及两组间比较,差异均无统计学意义( P>0.05)。术后 3、12 个月,两组患者 IKDC 评分及 Lysholm 评分均较术前显著改善,术后 12 个月较 3 个月时进一步改善( P<0.05);试验组均显著优于对照组( P<0.05)。术后 12 个月试验组双膝后向松弛度差异<5 mm 27 例,6~10 mm 2 例;对照组双膝后向松弛度差异<5 mm 20 例,6~10 mm 6 例,>10 mm 3 例;两组比较差异无统计学意义( Z=0.606, P=0.544)。术后 12 个月复查膝关节 MRI 提示所有患者 PCL 移植物走行良好,试验组 MRI 评分优于对照组( t=2.425, P=0.019)。术后 3、12 个月复查 CT 示,试验组股骨及胫骨骨隧道内口扩大程度均优于对照组,差异有统计学意义( P<0.05)。.
UNASSIGNED: PRP 辅助 3 股腓骨长肌腱重建 PCL 能够显著改善膝关节功能和稳定性,有效促进移植物重塑,并可促进腱-骨愈合,减少骨隧道扩大程度,临床疗效满意。.