背景临床表现,膝前稳定性,前交叉韧带(ACL)重建后的等速肌力主要受移植物选择的影响,股骨隧道准备,和股骨固定的类型。可膨胀的股骨固定装置有望通过圆形移植物压缩提供更强的初始固定,股骨中的盲端隧道,扩大较少,和通过移植物旋转的理论双带ACL等效。本研究旨在使用两种不同的解剖股骨固定技术(可扩张式和固定环扣)评估腿筋肌腱重建ACL后的等速肌力和功能能力。方法将48例ACL缺乏膝关节的男性患者随机分为两个不同的股骨固定组,即,可扩展(AperFix)和标准皮质(按钮)组。主要结果指标是等速腿筋和股四头肌力量能力,以及在60度/秒(°/s)和180°/s时使用Cybex的腿筋/股四头肌比率,六,九,术后12个月和24个月。二次测量是在两年时的前后膝关节稳定性(使用KT-1000关节计)和使用国际膝关节文献委员会(IKDC2000)表格的功能结果,Tegner活动量表,还有Lysholm膝盖得分.数据采用配对t检验和方差分析进行比较,具有P<0.05的显著性水平。结果大多数患者在3至12个月之间恢复了60°/s的股四头肌力量(Button组的62.5%与AperFix组的50%),以及180°/s强度(79.17%vs70.83%);然而,在24个月的评估中,Button组7例(29.17%)患者和AperFix组5例(20.83%)患者存在显著缺陷.Button组19例(79.17%)患者和AperFix组16例(66.7%)患者在前6个月恢复了60°/s屈肌力量,而180°/s强度的百分比分别为79.17%和75%,分别。除了24个月的评估,Button组只有3例(12.5%)患者和AperFix组4例(16.67%)患者有显著的屈肌缺损.关于H/Q比,在60°/s时,Button和AperFix组的平均恢复时间为6个月和7.5个月,分别,而15和12名患者,分别,在两年的时间里没有恢复。在180°/s时,纽扣组需要六个月的平均恢复时间,9名患者两年后没有康复。对于AperFix组,需要九个月,12名患者在两年内没有康复。两组之间的临床表现和前膝稳定性无统计学差异。结论虽然临床表现无显著差异,膝关节稳定性,可扩张和皮质纽扣股骨固定组之间的等速运动强度测试,术后两年重返赛场令人怀疑。
Background Clinical performance, anterior knee stability, and isokinetic strength after anterior cruciate ligament (ACL) reconstruction with hamstring autografts are mainly influenced by graft selection, femoral tunnel preparation, and type of femoral fixation.
Expandable femoral fixation devices are expected to provide a stronger initial fixation with circular graft compression, a blind-ended tunnel in the femur with less enlargement, and a theoretical double-band ACL equivalent through graft rotation. This study aimed to evaluate isokinetic strength and functional capacity after ACL reconstruction with hamstring tendons using two different anatomical femoral fixation techniques (
expandable vs fixed-looped button). Methodology A total of 48 male patients with ACL deficient knees were randomized to two different femoral fixation groups, namely, the
expandable (AperFix) and the standard cortical (Button) group. The primary outcome measures were isokinetic hamstrings and quadriceps strength capabilities and the hamstrings/quadriceps ratio at 60 degrees/second (°/s) and 180°/s using a Cybex before and at three, six, nine, 12, and 24 months after surgery. Secondary measurements were anteroposterior knee stability at two years (using KT-1000 arthrometer) and the functional outcome using the International Knee Documentation Committee (IKDC 2000) form, the Tegner activity scale, and the Lysholm knee score. Data were compared using a paired t-test and analysis of variance, with a p < 0.05 level of significance. Results Most patients regained the 60°/s quadriceps strength between three and 12 months (62.5% for the Button group vs. 50% for the AperFix group), as well as the 180°/s strength (79.17% vs 70.83%); however, at the 24-month evaluation, seven (29.17%) patients in the Button group and five (20.83%) in the AperFix group had significant deficits. The 60°/s flexor strength was regained in the first six months in 19 (79.17%) patients in the Button group and in 16 (66.7%) patients in the AperFix group, whereas the percentages for the 180°/s strength were 79.17% and 75%, respectively. Beyond the 24-month evaluation, only three (12.5%) patients in the Button group and four (16.67%) in the AperFix group had significant flexor deficits. Regarding the H/Q ratio, at 60°/s, the mean recovery time was six and 7.5 months for the Button and AperFix groups, respectively, whereas 15 and 12 patients, respectively, did not recover during the two-year duration. At 180°/s, a mean recovery time of six months was needed for the button group, and nine patients did not recover two years later. For the AperFix group, nine months were needed, and 12 patients did not recover in two years. Clinical performance and anterior knee stability showed no statistically significant differences between groups. Conclusions Although there were no significant differences in clinical performance, knee stability, and isokinetic strength testing between
expandable and cortical button femoral fixation groups, return to play was doubtful at two years postoperatively.