Is Partial ACL Tear a Cause of Painful Swollen Knees?

Hany Mohamed Abd Elfattah Bakr, Salah Mahmoud Abdelkader, Yamen Safwat
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Abstract

Retrospective case series. In this study, we will identify if partial ACL tear is a common hidden cause of chronic pain and swelling of the knee in adults. And we will evaluate the effectiveness of arthroscopic selective bundle reconstruction in the management of this condition. The Anterior Cruciate Ligament (ACL) has two anatomical bundles, the anteromedial (AM) and the posterolateral (PL), each bundle was named according to the site of its tibial insertion.[1] Partial ACL tear is evident and symptomatic when the percentage of the torn fibers is more than 50% of ligament fibers. AM bundle is more liable to injury than PL.[2] Symptomps of partial ACL tear may be giving way and instability but persistent knee pain and swelling is often present as the main presenting symptom of the patient due to micro-instability of the knee, The primary complication of longstanding partial ACL tears is early knee degeneration.[3] 37 patients with chronic knee pain and swelling, related to activity and resistant to non-operative treatment, underwent diagnostic knee arthroscopy. In 3 cases diagnostic arthroscopy revealed osteochondral ulcers of the medial compartment of the knee managed by drilling and 4 cases showed non-specific synovitis managed by arthroscopic synovectomy. 30 of these patients, who were included in this study, were found to suffer from partial ACL tear and underwent single bundle reconstruction, 18 of them underwent selective AM bundle reconstruction while preserving PL bundle. Twelve patients underwent selective PL bundle reconstruction with AM bundle preservation. Semitendinosus tendon graft was utilized for all reconstructions. The femoral side was always fixed with an adjustable loop (Zimmer), and the tibial side with a biodegradable interference screw. Lysholm score[4] was used to assess the outcomes. Patients with severe degenerative disorders, lower limb mal-alignment and multiple ligamentous injuries of the knee were excluded from our study. Marked decrease in the knee pain and swelling postoperatively. The preoperative score had a mean value of 66.17±10.39. At 2 years, the postoperative score was 96.1±6.71, indicating a highly statistically significant improvement (P value 0.001). Partial ACL tears are the commonest hidden cause of pain and swelling of the knee among young adults. Arthroscopic selective bundle reconstruction diminishes knee pain and swelling with a very satisfactory postoperative clinical outcomes.
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前交叉韧带部分撕裂是导致膝盖肿痛的原因吗?
回顾性病例系列。 在这项研究中,我们将确定前交叉韧带部分撕裂是否是导致成人膝关节慢性疼痛和肿胀的常见隐性原因。我们还将评估关节镜下选择性捆绑重建术在治疗这种情况方面的有效性。 前交叉韧带(ACL)有两个解剖学束,分别是前内侧束(AM)和后外侧束(PL),每个束都是根据其胫骨插入部位而命名的。AM束比PL束更容易受伤[2]。前交叉韧带部分撕裂的症状可能是让位和不稳定,但由于膝关节的微不稳定,持续性膝关节疼痛和肿胀往往是患者的主要表现症状。其中 3 例患者通过关节镜诊断发现了膝关节内侧的骨软骨溃疡,并通过钻孔术进行了治疗;4 例患者通过关节镜滑膜切除术发现了非特异性滑膜炎,并进行了治疗。本研究中的 30 例患者被发现患有前交叉韧带部分撕裂,并接受了单束重建术,其中 18 例患者接受了选择性 AM 束重建术,同时保留 PL 束。12名患者在保留AM束的情况下进行了选择性PL束重建。所有重建手术均采用半腱肌腱移植。股骨侧始终使用可调节环(Zimmer)固定,胫骨侧则使用生物可降解过盈螺钉固定。Lysholm评分[4]用于评估结果。研究排除了严重退行性疾病、下肢错位和膝关节多处韧带损伤的患者。 术后膝关节疼痛和肿胀明显减轻。术前评分的平均值为(66.17±10.39)分。2 年后,术后评分为 96.1±6.71,这表明膝关节疼痛和肿胀的改善具有高度统计学意义(P 值为 0.001)。 前交叉韧带部分撕裂是青壮年膝关节疼痛和肿胀最常见的隐性原因。 关节镜下选择性捆绑重建可减轻膝关节疼痛和肿胀,术后临床效果非常理想。
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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
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0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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