동종건을 이용한 관절경적 전방십자인대 재건술에서 남아있는 조직의 보존
Preserving Remnant Tissue in Arthroscopic ACL Reconstruction Using Achilles Tendon Allograft
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목적: 동종 아킬레스건을 이용한 전방십자인대 재건술에서 파열된 인대의 잔류조직을 보존하는 방법의 임상 결과를 분석하고자 한다. 대상 및 방법: 2004년 4월부터 2007년 6월까지 동종 아킬레스건을 이용한 전방십자인대 재건술을 시행한 환자들 중 수술 후 12개월 이상 추시 관찰이 되었던 26명을 대상으로 하였다. 이들을 남아있는 조직 보존 여부에 따라 잔류조직 보존군과 잔류조직 제거군 두 군으로 나누었다. 수술 후 pivot-shift 검사, 전방 전위 검사(Telos anterior stress test), International Knee Documentation Committee (IKDC) scale, Lysholm score 및 편측 하지 지지검사(single limb standing test)를 이용하여 평가하였다. 결과: 두 군 사이에서 기계적인 안정성 및 IKDC scale과 Lysholm score에서 의미있는 차이는 보이지 않았다. 남아있는 조직의 보존한 군에서 건측 하지와 환측 하지의 편측 하지 지지 검사는 유의한 차이를 보이지 않았지만, 남아있는 조직을 보존한 군이 1.1±0.8 cm, 남아있는 조직을 제거한 군이 1.8±1.2 cm로 편측 하지 지지 검사 결과 유의한 차이를 보였다(p=0.04). 결론: 동종 아킬레스 인대를 이용한 전방십자인대 재건술은 슬관절 안정성 및 기능 회복에 좋은 결과를 보여주었으며, 남아있는 조직을 보존하는 것은 고유수용감각 회복에 도움을 주는 것으로 생각된다.
Abstract
Purpose: The purpose of this study was to determine the clinical usefulness of remnant preservation in anterior cruciate ligament (ACL) reconstruction using Achilles tendon graft. Materials and Methods: Between April 2004 and June 2007, 26 patients who were followed up for at least 12 months after ACL reconstruction with Achilles tendon were included in this study. They were divided into two groups according to whether the remnant was preserved. The post-reconstruction state was evaluated using pivot-shift test, Telos anterior stress test, International Knee Documentation Committee (IKDC) scale, Lysolm score and single limb standing test. Results: No statistically significant differences in mechanical stability and mean values of IKDC scale and Lysholm test between the two groups were present. In single limb standing test, the remnant-preserving group showed 1.1±0.8 cm and the remnant sacrificing group showed 1.8±1.2 cm (p=0.04). However, there were no significant differences between the injured knee and the intact knee in the group which the remnant was preserved. Conclusion: ACL reconstruction using allo Achilles graft showed satisfactory results in terms of stability and function. Preserving the tibial remnant seems to be helpful to restore knee joint proprioception.
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