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Quality control following anterior cruciate ligament reconstruction

Evaluation des reconstructions du ligament croisé antérieur

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Résumé

Une évaluation fonctionnelle objective a été effectuée après réparation unilatérale de rupture du ligament croisé antéro-externe (LCAE) dans une série homogène de 37 patients, avec un recul moyen de 44,4 mois par rapport au traumatisme. Un questionnaire, un contrôle clinique standardisé, des tests instrumentaux de laxité ligamentaire ainsi qu'une évaluation du moment de torsion musculaire isokinétique concentrique furent utilisés. Le contrôle instrumental de la laxité ligamentaire peut être considéré comme très proche du test d'instabilité du pivot (r = 0,54, p < 0,001) et le signe de Lachman (r = 0,73, p < 0,001) mais est plus rapidement décisif. Le degré d'instabilité antérieure mesuré pourrait être considéré comme corrélé négativement avec le moment de torsion musculaire isokinétique concentrique (r = 0,61, p < 0,001) et le rapport ischio-jambiers/quadriceps (r = 0,44, p < 0,005). Les différences entre les sujets des tests instrumentaux de laxité ligamentaire révèlèrent qu'un degré significatif d'instabilité (> 2 mm) existait chez 49 % des patients, ce qui contraste avec les bons résultats au score de Lysholm (moyenne : 84,5 points) et une proportion de 74 % de patients satisfaits. Ainsi le test instrumental de laxité ligamentaire apporte-t-il une contribution importante à l'évaluation fonctionnelle post-opératoire des ligamentoplasties du LCAE.

Summary

An objective functional evaluation after acute repair of unilateral anterior cruciate ligament (ACL) rupture was performed in a homogeneous group of 37 patients at a mean of 44.4 months after trauma. A patient questionnaire, standardized clinical testing, instrumented laxity testing and concentric isokinetic muscle torque evaluation were included. Instrumented laxity testing proved to be closely correlated with the pivot shift test (r=0.54, p<0.001) and the Lachman test (r=0.73, p<0.001), but offered a far better resolution. The degree of anterior instability as measured could be shown to correlate negatively with the isokinetic flexor muscle torque (r=−0.61, p<0.001) and the hamstring/quadriceps ratio (r=−0.44, p<0.05). The intraindividual differences of instrumented laxity testing revealed that a significant degree of instability (>2 mm) was present in 49% of the patients contrasting with the good result in the Lysholm score (mean=84.5 pts.) and a 74% rate of satisfied patients. Instrumented laxity testing makes a significant contribution to objective evaluation of functional results after ACL repair.

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Lob, G.C., Mittlmeier, T., Stöcklein, S. et al. Quality control following anterior cruciate ligament reconstruction. Orthop Traumatol 4, 143–148 (1994). https://doi.org/10.1007/BF01788452

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