2022, Vol. 26 ›› Issue (21): 3281-3290

Autologous, mixed and ligament advanced reinforcement system ligaments reconstruction of anterior cruciate ligament: evaluation of bone tunnel enlargement value, ligament growth factor and knee function

Cao Fuyang, Xu Jianzhong, Lu Shitao, Tan Jun, Jiang Xu, Yang Meng, Shi Jianming, Chang Yingjian   

Abstract: BACKGROUND:   Anterior cruciate ligament knee reconstruction under arthroscopy is the most effective treatment for anterior cruciate ligament injury. However, the choice of graft in anterior cruciate ligament reconstruction is still controversial, which is the key problem to be solved facing clinicians.
OBJECTIVE: To explore the clinical efficacy of autologous, mixed, and simple ligament advanced reinforcement system ligaments in anterior cruciate ligament reconstruction.  
METHODS: Totally 132 patients who were admitted to First Affiliated Hospital of Zhengzhou University from January 2016 to January 2019 and underwent anterior cruciate ligament reconstruction were enrolled in this study. These patients were divided into autologous group, mixed group, and artificial group (n=44) according to the different graft selections. Among them, the autologous group took the medial half tendon and femoral tendon of the calf tibial nodules and woven into autologous ligament for treatment. Patients in the mixed group were treated with semi-tendon, femoral tendon and ligament advanced reinforcement system artificial ligament graft. Patients with the artificial group were treated with ligament advanced reinforcement system artificial ligament. Before and 2 years after operation, Lysholm score, International Knee Documentation Committee (IKDC) score, Lachman test, Tegner score, and HSS score were used to evaluate the recovery of the knee. At the same time, the bone tunnel enlargement value, ligament growth factors, quality of life, and recovery time were observed.
RESULTS AND CONCLUSION: (1) The time for patients in the mixed group to resume daily activities and exercise after surgery was earlier than that of the autologous group and the artificial group (P < 0.05). The SF-36 score of the quality of life 2 years after surgery was higher in the mixed group than that of the autologous group and the artificial group (P < 0.05). The complication rates of the mixed group and the artificial group were lower than that of the autologous group (P < 0.05). (2) The knee joint function of the three groups of patients recovered to varying degrees. The Lysholm score, IKDC score, and Tegner score of the mixed group were higher than those of the autologous group and the artificial group at 0.5, 1, and 2 years after operation (P < 0.05). The KT1000 knee range of motion of the mixed group was less than that of the autologous group and the artificial group (P < 0.05) at 1 and 2 years after operation. The bone tunnel enlargement value at 1 year after operation was lower in the mixed group than that of autologous group and artificial group (P < 0.05). The HSS scores at 0.5, 1, and 2 years after operation were higher in the mixed group than those of the autologous group and the artificial group (P < 0.05). The number of normal people in Lachman test at 2 years after operation was more in the mixed group than that of autologous group and artificial group (P < 0.05). (3) The levels of ligament growth factor transforming growth factor β1 and basic fibroblast growth factor in the mixed group were higher than those in the autologous group and the artificial group at 0.5, 1, and 2 years after surgery (P < 0.05). (4) It is concluded that the mixed ligament can be used as the primary graft for clinic, and is more helpful in helping patients return to normal work and life as soon as possible. However, the use of mixed ligaments still has practical problems, such as the need to extract autologous tendons and high medical costs.
Key words: orthopedic implant, autologous ligament, ligament advanced reinforcement system, mixed ligament, anterior cruciate ligament, injury, reconstruction, functional scores, recovery