Early curative effects of anterior cruciate ligament reconstruction with the peroneus longus tendon combined with one-stage repair of severe medial collateral ligament injury using suture anchors
SHI Fu-dong
ZUO Jin-zeng
LIU Shi-jie
ZHANG Yong
LIU Tian-hong
WU Qiang
MA Hai-yang
WANG Xue-chen
LI Chang-jiang
Abstract：Objective To investigate the early curative effects of anterior cruciate ligament ( ACL ) reconstruction with the peroneus longus tendon combined with one-stage repair of severe medial collateral ligament ( MCL ) injury using suture anchors.Methods From December 2008 to October 2012, a total of 38 patients with acute ACL tears and grade III MCL injuries underwent arthroscopic reconstruction with the ipsilateral autologous peroneus longus tendon and the semitendinosus allograft. There were 18 cases of ACL reconstruction with the ipsilateral autologous peroneus longus tendon ( group A ) and 20 cases with the semitendinosus allograft ( group B ). The suture anchors were used in all cases of MCL injuries. After the postoperative brace immobilization in the straight position for 1 week, the patients began the practice of knee lfexion and extension. The lfexion angle was gradually increased, and 6 weeks after the operation it reached more than 120 degrees. All patients were examined in the following objective indexes at 6 and 12 months after the operation respectively, including the stability of the knee ( KT-1000, 134 N forward tension ), Lachman test, pivot shift test, thigh circumference difference and knee Magnetic Resonance Imaging ( MRI ). Subjective evaluation of the motor functions in the patients was performed using the Tegner scale, Lysholm scale and International Knee Documentation Committee ( IKDC ) knee function scale. Reconstruction was performed in the foot with a 16-slice CT scanner preoperatively and postoperatively. The width of the transverse arch of the foot and the height and apex angel of the inner and outer longitudinal arches were measured. The above results were compared.Results Based on the preoperative Tegner scores and Lysholm scores, P values were more than 0.05 and the differences were not statistically signiifcant. The Lachman test was negative in 16 cases ( 88.89% ) in the 6th months after the operation and I positive in 2 cases ( 11.11% ) in group A, with no positive cases of more than II degrees. It was negative in 17 cases ( 85.00% ) and I positive in 3 cases ( 15.00% ) in group B, with no positive cases of more than II degrees. The pivot shift test was positive in 1 case in group A, and negative in all the other cases. It was positive in 1 case in group B, and negative in all the other cases. The KT-1000 examination with the forward tension of 134 N showed that the side to side difference of anterior laxity was less than 2 mm in 15 cases ( 88.33% ) and -5 mm in 3 cases ( 16.67% ) in group A, with no cases of more than 5 mm ( 0.00% ). It was less than 2 mm in 16 cases ( 80.00% ), -5 mm in 3 cases ( 15.00% ) and more than 5 mm in 1 case ( 5.00% ) in group B. The circumference differences of both lower limbs were ( 1.06±0.86 ) cm in group A and ( 1.04±0.92 ) cm in group B. The Tegner scores were ( 6.00±0.46 ) points in group A and ( 6.00±0.57 ) points in group B. The Lysholm scores were ( 94.00±6.02 ) points in group A and ( 95.00±2.35 ) points in group B. The IKDC knee function scores were ( 89.45±2.89 ) points in group A and ( 90.12±4.56 ) points in group B. The differences in each index between the 2 groups were not statistically signiifcant (P>0.05 ). At 1 year after the operation, the Lachman test was negative in 15 cases ( 83.33% ) and I positive in 3 cases ( 16.67% ) in group A, with no positive cases of more than II degrees. It was negative in 16 cases ( 80.00% ), I positive in 1 case ( 5.00% ) and II positive in 2 cases ( 10.00% ) in group B. The pivot shift test was positive in 2 cases in group A, and negative in all the other cases. It was positive in 2 cases in group B, and negative in all the other cases. The KT-1000 examination with the forward tension of 134N showed that the side to side difference of anterior laxity was less than 2 mm in 14 cases ( 77.78% ) and -5 mm in 4 cases ( 22.22% ) in group A, with no cases of more than 5 mm ( 0.00% ). It was less than 2 mm in 16 cases ( 80.00% ), -5 mm in 3 cases ( 15.00% ) and more than 5 mm in 1 case ( 5.00% ) in group B. The circumference differences of both lower limbs were ( 1.01±0.21 ) cm in group A and ( 1.03±0.12 ) cm in group B. The Tegner scores were ( 5.00±0.96 ) points in group A and ( 6.00±0.03 ) points in group B. The Lysholm scores were ( 94.00±6.67 ) points in group A and ( 95.00± 3.55 ) points in group B. The IKDC knee function scores were ( 90.48±2.36 ) points in group A and ( 90.17±4.32 ) points in group B. The differences in each index between the 2 groups were not statistically signiifcant (P>0.05 ). After a mean follow-up of 18 months, the measurement results by the 16-slice CT scanner showed that there were not statistically signiifcant differences in the width of the transverse arch and the height and apex angel of the inner and outer longitudinal arches of the foot before and after the operation.Conclusions For the patients with acute ACL tears and grade III MCL injuries, satisfactory early results can be obtained after the ACL reconstruction with the ipsilateral autologous peroneus longus tendon and the semitendinosus allograft combined with the one-stage repair of MCL injury using suture anchors are performed. There are no statistically significant differences between them. The ipsilateral autologous peroneus longus tendon may be a good choice in the ACL reconstruction when grade III MCL injury occur. The early results are good at the same time with the one-stage repair of MCL injuries using suture anchors.
Keywords：Anterior cruciate ligament ( ACL )Medial collateral ligament ( MCL )ArthroscopeSuture anchorPeroneus longus tendon
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 38-44 )