Objective: To investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury.
Methods: Between June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury.
Results: The operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores ( t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score ( t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases.
Conclusion: The method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.
目的: 探讨关节镜下 GraftLink 技术重建前交叉韧带（anterior cruciate ligament，ACL）联合带线锚钉固定修复内侧副韧带（medial collateral ligament，MCL）Ⅲ度损伤的疗效。.
方法: 2015 年 6 月—2018 年 2 月，收治 28 例 ACL 断裂合并 MCL Ⅲ度损伤患者。关节镜下采用 GraftLink 技术以自体腓骨长肌腱（peroneus longus tendon，PLT）重建 ACL，带线锚钉固定修复 MCL。男 22 例，女 6 例；年龄 21～47 岁，平均 30.4 岁。受伤原因：交通事故伤 18 例，高处坠落伤 7 例，运动损伤 3 例。受伤至入院时间 1～2 周，平均 1.3 周。术前膝关节 Lysholm 评分为（46.8±3.0）分，国际膝关节文献委员会（IKDC）评分为（49.2±2.7）分。踝关节美国矫形足踝协会（AOFAS）评分为（98.29±0.72）分。Lachman 试验及外翻应力试验均为阳性。合并半月板损伤 8 例，软骨损伤 2 例。.
结果: 手术时间 55～90 min，平均 72.5 min。术后切口均Ⅰ期愈合，无手术相关并发症发生。患者均获随访，随访时间 6～38 个月，平均 20.7 个月。术后 3 个月膝关节活动度为 116～132°，平均 122°。Lachman 试验 2 例胫骨前移<5 mm，其余均为阴性；外翻应力试验均为阴性。术后 6 个月，膝关节 Lysholm 评分为（90.2±1.8）分、IKDC 评分为（93.5±2.3）分，明显高于术前（ t=31.60， P=0.00； t=29.91， P=0.01）；踝关节 AOFAS 评分为（97.86±0.68）分，与术前比较差异无统计学意义（ t=2.89， P=0.08）。术后 6 个月，KT-1000 测量双侧膝关节前向松弛度差值<2 mm 者 25 例，3～5 mm 者 3 例。.
结论: 关节镜下采用 GraftLink 技术以 PLT 重建 ACL 联合带线锚钉固定修复 MCL，具有膝关节损伤小、恢复快的优点，且取腱后对踝关节功能无明显影响。.
Keywords: Arthroscopy; GraftLink technique; anterior cruciate ligament; autologous tendon; medial collateral ligament; suture anchor.