전방십자인대 및 내측부인대 동반손상 환자에서 전방십자인대의 조기 재건군과 지연 재건군의 결과 비교
Comparison of Early and Delayed Reconstruction of the ACL in Combined Injuries of the ACL and MCL of the Knee
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목적: 슬관절의 전방십자인대와 내측측부인대의 동반손상이 있는 환자에서 전방십자인대의 조기 재건술과 지연 재건술 간의 결과를 비교하고자 하였다. 대상 및 방법: 2001년 2월부터 2007년 1월까지 전방십자인대와 내측측부인대 동반손상이 있는 환자 중 전방십자인대 재건술을 시행받고 최소 1년 6개월 이상 추시가 가능하였던 55예(55명)를 대상으로 하여 이를 3주 이내에 전방십자인대 재건술을 시행한 조기 재건군과 3주 이후 재건술을 시행한 지연 재건군으로 나눠 Tegner 활동도 점수와 Lysholm 슬관절 점수, 관절 운동을 시작한 후 관절 운동이 90^o가 되기까지의 기간, Lachman test 결과와 전방 전위 긴장 방사선 검사, 외반 긴장 방사선 검사, 그리고 International Knee Documentation Committee (IKDC) 주관적 만족도를 비교하였다. 결과: 최종 추시 시 Tegner활동도 점수는 조기 재건군의 경우 7.4점, 지연 재건군은 7.6점이었으며, Lysholm 슬관절 점수는 조기 재건군의 경우 90.5점, 지연 재건군은 91.3점으로 나타났다(p=0.24, p=0.31). IKDC주관적 만족도는 전례에서 거의 정상 상태로 회복되었다. 관절 운동 회복 기간은 조기 재건군에서, 특히 여성에서 더 오래 걸렸으나, 최종 추시시의 관절운동범위는 양군 간의 차이는 없었으며, Lachman test와 전방 및 외반 긴장 방사선 검사 또한 양군 간의 유의한 차이는 없었다. 결론: 본 연구에서는 전방십자인대의 조기 및 지연 재건군 모두에서 만족할 만한 임상적, 방사선학적 결과를 얻었다. 이는 조기 재건술도 전방십자인대와 내측측부인대 동반손상의 좋은 치료 방법으로 선택될 수 있을 것으로 생각된다.
Abstract
Purpose: The aim of this study was to compare the results between early and delayed reconstruction of the anterior cruciate ligament (ACL) in patients with combined medial collateral ligament (MCL) injuries. Materials and Methods: From February 2001 to January 2007, fifty-five patients who had undergone ACL reconstruction for combined ACL and MCL injuries and who were followed for more than 18 months were included in this study. The Tegner Activity Score, the Lysholm Knee Scoring Scale, the interval to recover 90o of motion, the Lachman test, the anterior and valgus laxity noted on stress radiograph, and the International Knee Documentation Committee (IKDC, 1993) documentation were recorded and compared between the early reconstruction group, which underwent ACL reconstruction within 3 weeks, and the delayed reconstruction group, which underwent ACL reconstruction after 3 weeks. Results: At the final follow up, the Tegner score was 7.4 in the early reconstruction group and 7.6 in the delayed reconstruction group. The Lysholom score was 90.5 and 91.3, respectively (p＞0.05). All the cases were rated near normal or normal on the IKDC subjective assessment. The early reconstruction group needed a longer time to recover motion and especially in the female patients. However, there was no statistical difference between the groups for the final range of motion, in addition to the Lachman test and the anterior or valgus laxity. Conclusion: In this study, satisfactory clinical and radiological results were obtained in both the early and delayed reconstruction groups. The early reconstruction of the ACL seems to be one of the surgical options for reconstruction of acute ACL injury combined with torn MCL.
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