摘要目的 探讨慢性前交叉韧带(ACL)损伤不稳定膝关节合并骨关节炎患者是否适于进行ACL重建术以及治疗效果.方法 12例慢性ACL损伤合并膝关节不稳定和骨关节炎患者,年龄35 ～ 54岁(平均46岁).既往没有确诊过ACL损伤和进行相应治疗.所有患者均有明显膝关节前向不稳,有一个或多个膝关节不稳定的临床表现,症状持续时间1～5年.均采用自体单束四股胭绳肌腱重建ACL,并同时进行相应病变的处理.采用Lachman试验和轴移试验评价韧带稳定性,采用改良的Lysholm评分进行患者主观症状的评价.结果 12例患者中9例合并明显的内侧间室软骨磨损退变,10例合并内侧半月板后角复合撕裂.随访9～36个月,没有移植物失败,所有患者膝关节不稳定症状和关节的稳定性均明显改善.改良的Lysholm评分从术前的62.0分增加到89.5分.结论 慢性前交叉韧带损伤的不稳定膝关节合并骨关节炎患者,在严格选择适应证的前提下进行ACL重建,能获得满意的临床效果.

abstractsObjective Untreated ruptures of anterior cruciate ligament (ACL) lead to progressive meniscus tear and development of knee osteoarthritis over decades.The present study was designed to explore the early results of ACL reconstruction for the patients with unstable ACL-deficient knee with osteoarthritis.Methods Twelve patients with a mean age of 46 years (range:35 -54) underwent ACL reconstruction for ACL-deficient knee with osteoarthritis.All had chronic anterior instability and one or more episodes of knee instability.There was no previous diagnosis of ACL ruptures and no prior ligament surgery on involved knee.The preoperative duration of symptoms was 1 to 5 years.ACL reconstruction with arthroscopic single-bundle four-strand hamstring tendon autograft was performed for all patients.The laxity of knee was determined with Lachman and pivot tests.The patient subjective evaluation of function was examined with the modified Lysholm scoring scale pre- and post-operatively.Results Obvious articular cartilage degeneration and cartilage space stenosis in medial compartment were found in 9 patients and complex medial meniscus tear in 10.During the follow-up period of 9 -36 months,there was no graft failure or loss of ROM ( range of motion) for any of these knees.The symptoms of instability were relieved in all patients.The post-operative knee stability improved markedly.The modified Lysholm scores improved from a median pre-operative score of 62.0 points to an average of 89.5 at the last follow-up.Conclusion ACL reconstruction with hamstring tendon may significantly relieve symptoms and improve knee functions in the patients of chronic anterior cruciate ligament-deficient knee with osteoarthritis,especially in those with primary symptoms of instability.