자가 슬건과 슬개건을 이용한 관절경적 전방십자인대 재건술의 단기 추시 결과 비교

서재성(Jae Sung Seo),이동철(Dong Chul Lee),손욱진(Oog Jin Shon),장우혁(Woo Hyuk Jang),김세동(Se Dong Kim) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.1

목적: 자가 슬건과 슬개건을 이용한 관절경적 전방십자인대 재건술의 술후 결과를 임상적, 방사선적으로 분석하여 비교하여 비교하고자 하였다. 대상 및 방법: 1997년 9월부터 2003년 1월까지 전방십자인대 재건술을 시행받은 환자들 중 추시기간이 18개월 이상인 자가 슬건 군 22예와 자가 슬개건 군 30예를 대상으로 하였다. 임상적 평가는 IKDC 평가법, Lysholm 점수, Tegner 점수를 이용하였으며 방사선적 평가는 Telos기기를 이용하여 90도 굴곡위에서 전방 전위도를 정상측과 비교하였고 무릎을 꿇은 상태에서 나타나는 전방 슬부 동통의 빈도, 대퇴 사두근의 위축 정도 등을 비교하였다. 결과: IKDC 평가법에 의하면 슬건 군은 A등급 2예, B등급 14예, C등급 6예였고 슬개건 군은 A등급 3예, B등급 20예, C등급 7예로 두 군간에 차이가 없었다. Lysholm 점수는 슬건 군이 술 전 평균 58.2점에서 최종 추시상 평균 88점으로, 슬개건 군은 평균 56.3점에서 평균 90.6점으로 호전되었고, Tegner 점수는 슬건 군이 술 전 평균 2.4점에서 최종 추시상 평균 5.8점으로, 슬개건 군은 평균 2.3점에서 평균 6.2점으로 활동도가 증가되었으나 두 군 간에 차이가 없었다. Telos기기를 이용한 최종 추시 전방 전위도는 슬건 군이 정상측과 평균 2.6 ㎜의 차이를 보였고 슬개건 군이 평균 2.3 ㎜의 차이를 보여 두 군간에 차이가 없었다. 무릎을 꿇은 상태에서 나타나는 전방 슬부 동통은 슬건 군이 2예(13%), 슬개건 군이 11예(37%)로 통계적인 차이를 보였다(p<0.05). 결론: 슬건을 이용한 관절경적 전방십자인대 재건술은 무릎을 꿇은 상태에서 나타나는 전방 슬부 동통의 빈도를 낮출 수 있으며 슬개건과 비슷한 정도의 만족할 만한 인대 안정성 및 임상적 결과를 얻을 수 있었다. Purpose: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. Results: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 ㎜ in the hamstring group vs 2.3 ㎜ in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). Conclusion: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.

Correlation between Hamstring Flexor Power Restoration and Functional Performance Test: 2-Year Follow-Up after ACL Reconstruction Using Hamstring Autograft

( Min Soo Ko ),( Sang Jin Yang ),( Jeong Ku Ha ),( Jung Yun Choi ),( Jin Goo Kim ) 대한슬관절학회 2012 대한슬관절학회지 Vol.24 No.2

Purpose: To evaluate the restoration of the flexor power and the correlation between the flexor power and functional performance tests (FPTs) after anterior cruciate ligament (ACL) reconstruction with hamstring autograft. Materials and Methods: Twenty-three men, who underwent ACL reconstruction with hamstring autograft, were evaluated using Lysholm, Subjective IKDC, Tegner activity score, isokinetic flexion and hyperflexion power test, and the FPTs at 1 and 2-year follow-up. We analyzed the mean change from 1 to 2 year and the correlation between both the flexion and hyperflexion power deficit with the FPTs at each follow-up. Results: Mean age of the patients was 30.9 years (range, 19 to 44). Tegner activity score was significantly increased from 5.7 to 6.3 (p=.010). Hyperflexion power of the involved knee deficits significantly decreased at 2 year follow-up compared with 1 year (p<.001). There was a correlation between the flexor power deficit and the co-contraction, carioca, and involved one-legged hop test at each follow-up. However, no significant correlations were revealed between the hyperflexion power deficit and the FPTs. Conclusions: Hyperflexion power deficit after ACL reconstruction with the hamstring autograft decreased at 2 year follow-up compared to 1 year and does not affect the results of the FPTs.

A Comparative Study of Clinical Outcomes and Second-Look Arthroscopic Findings between Remnant-Preserving Tibialis Tendon Allograft and Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Matched-Pair Design

김유근,안종현,유재두 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.4

Background: This study aimed to compare stability, functional outcome, and second-look arthroscopic findings after anterior cruciate ligament reconstruction between remnant-preserving tibialis tendon allograft and remnant-sacrificing hamstring tendon autograft. Methods: We matched two groups (remnant-preserving tibialis tendon allograft group and hamstring tendon autograft group) in terms of demographic characteristics, associated injury, and knee characteristics. Each group consisted of 25 patients. Results: Operation time was longer in the remnant-preserving tibialis tendon allograft group, but there was no significant intergroup difference in stability, clinical outcome, and second-look arthroscopic findings. Conclusions: When an autograft is not feasible in anterior cruciate ligament reconstruction, the remnant-preserving technique can produce comparable results in terms of restoration of function, stability of the knee, and degree of synovium coverage at second-look arthroscopy compared to remnant-sacrificing hamstring autograft.

Changes in hamstring strength after anterior cruciate ligament reconstruction with hamstring autograft and posterior cruciate ligament reconstruction with tibialis allograft

Lee O-Sung,이용석 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Aim: The aim of this study was to evaluate the changes in hamstring strength both after anterior cruciate ligament reconstruction (ACLR) with hamstring autograft followed by early rehabilitation and posterior cruciate ligament reconstruction (PCLR) with tibialis allograft followed by delayed rehabilitation. Methods: Isokinetic strengths of the quadriceps and hamstring muscles and endurances were compared between a group of 20 patients undergoing PCLR using a tibialis anterior allograft and a 1:2 matched control group of 40 patients undergoing ACLR using a hamstring autograft at 2 years after the operations. Clinical results were also compared using stability tests and the Lysholm and the International Knee Documentation Committee scores. Results: At 2 years after the operations, the torque deficit of the hamstring muscle in the involved leg compared to the uninvolved leg at both 60°/s and 120°/s was greater in the PCLR group than in the ACLR group (60°/s, 21.8 ± 14.0% versus 1.9 ± 23.9%, P = 0.0171; 120°/s, 15.3 ± 13.7% versus −0.7 ± 17.4%, p = 0.012, respectively). The peak torque of the hamstring muscle at 120°/s was significantly lower in the involved leg than in the uninvolved leg only in the PCLR group (71.3 ± 31.9 N∙m versus 81.9 ± 27.8 N∙m, P = 0.005). There was no significant difference in the clinical results between the groups except for a side-to-side difference in the tibial translation on Telos stress radiographs. Conclusion: The strength of the hamstring of the PCLR leg with allograft was significantly weaker than that of the unoperated leg after 2 years, whereas that of the ACLR leg with hamstring autograft maintained a similar level of strength compared to that of the uninvolved leg.

자가 슬건과 동종 전경골건을 이용한 전방십자인대 재건술 후 시행한 이차 관절경의 결과 비교

김명호 ( Myung Ho Kim ),유문집 ( Moon Jib Yoo ),박희곤 ( Hee Gon Park ),유현열 ( Hyun Yul Yoo ),이대희 ( Dae Hee Lee ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.1

Purpose: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. Materials and Methods: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. Results: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. Conclusion: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

전방십자인대 재건술의 이식건 종류에 따른 재활운동의 효과

한승훈,남종철,박정준 대한운동학회 2014 아시아 운동학 학술지 Vol.16 No.4

[PURPOSE] The purpose of this study was to define the effective type of graft for recovery of knee funtion by modified rehabilitation programs for hamstring tendon autograft(HAG) and tibialis tendon allograft(TAG) after anterior cruciate ligament(ACL) reconstruction. [METHODS] After ACL reconstruction, 5 patients with HAG and 5 patients with TAG performed 12 weeks of modified rehabilitation specially designed for each type of graft. At 6 week and 12 week of rehabilitation, knee function(extensor strength, flexor strength, hyperflexor strength), dynamic balance ability and Lysholm knee scoring scale were measured. [RESULTS] After 12 weeks of rehabilitation, there was significant interaction between time and group for extensor strength at 60 deg/sec(p<.05). Extensor strength was significantly higher in TAG than HAG at 6 weeks of rehabilitation(p<.05), but there was no difference in two groups at 12 weeks of rehabilitation. Flexor strength, hyperflexor strength, dynamic balance ability and Lysholm knee scoring scale were all significantly improved in both groups after rehabilitation(p<.05). [CONCLUSIONS] Improvements in extensor strength of HAG were lower than TAG at the first half of rehabilitation, but faster than TAG at the second half of rehabilitation so that there was no difference at the end of rehabilitation. However, improvements in flexor strength and endurance, hyperflexor strength and endurance, dynamic balance ability and Lysholm knee scoring scale were not different between HAG and TAG. These results indicate that there were generally no differences in effects of rehabilitation between HAG and TAG. [목적] 본 연구의 목적은 자가 슬건과 동종 경골건을 이용한 전방십자인대 재건술 후 이식건 종류에 적합하도록 수정된 재활운동 프로그램을 적용하여 슬관절 기능회복에 효과적인 이식건의 종류를 알아내는데 있다. [방법] 전방십자인대 재건술을 받은 환자를 대상으로 자가 슬건군(HAG) 5명, 동종 경골건군(TAG) 5명으로 나누어 12주간 각각의 재활운동 프로그램을 실시하였다. 재활운동 참여 6주와 12주에 슬관절 근기능(신전력, 굴곡력, 과굴곡력), 동적 균형능력과 Lysholm score를 측정하였다. [결과] 12주간 재활운동 후 신전력 60 deg/sec와 180 deg/sec에서 시기와 그룹 간 유의한 상호작용이 나타났다(p<.05). 재활운동 6주 후 신전력은 TAG가 HAG 보다 유의하게 높게 나타났으나(p<.05), 12주에는 유의한 차이가 없었다. 두 그룹 모두 슬관절 근기능, 동적 균형능력 및 Lysholm score이 유의하게 증가하였다(p<.05). [결론] 전방십자인대 재건술의 이식건 특성에 적합한 재활운동을 적용하였을 때 HAG의 신전력 회복은 재활운동 초기에는 TAG 보다 낮았지만 후반부에서 빠르게 증가하여 12주 후에는 차이가 없었다. 또한, 굴곡력, 과굴곡력, 동적 균형능력 및 Lysholm score 향상 역시 그룹 간 차이는 없었다. 이러한 결과는 HAG와 TAG 간 재활운동 효과에 큰 차이는 없다는 것을 의미한다. 다만, 재활운동이 지속된다면 신전력 향상에 있어서는 HAG가 좀 더 효과적일 가능성은 있다고 생각된다.