자가 이식편에 의한 전방십자인대 재건술의 실패요인 - 침해 ( Impingement ) 에 대하여

The aim of this study was to investigate the influnce of impingement of the geaft by intercondylar roof to stability of the joint and clinical result after reconstruction of anterior cruciate ligament(ACL) with bone-patellar tendon-bone graft. Among 74 cases of ACL reconstruction were done by one tunnel arthroscopic technique from May l991 to February 1994,30 casas with excellent result and 4 cases with poor result were analysed by radiological measurements & stability assessed hy Lachiman test and KT-1000 arthrometer, OAK(Orthopadische Arbeitsgruppe Knie) knee score. Impingement was assessed by relationship between the locations of intersection points on tibial tunnel plateau rnade by the lines drawn along the tibial tunnel and the slope of femoral inteizondylar roof in full extension lateral roentgenogram. Impingement was defined as severe(group 1) which the line of tibial tunnel was in front of the line of intercondylar slope; moderate or non when the former was at the same point or behined the latter(group II). In addition to that, the degree of impingement was evaluated by dividing the distance between the intersection point of intercondylar slope line an anterior margin of tibial tunnel by the width of tibial tunnel, and expressed in terms of percentage. The were as follows; 1. There were 2 cases of group I(severe impingernent) and 32 cases of group II (moderate or no impingement) 2. Regarding the range of motion, one case of group I showed limitation of extension under l0 degrees, and one case of group II showed limitation of flexion under 15 degrees. 3. Lachman test was positive in one case of group I and 3 cases of group II, and negative in one case of y oup I illld 29 cases of group II. 4. Maximal manual displacement measured by KT-1000 arthrometer was 4.81.0 in group I and 1.0+- l.7 in group II(statistically significant difference al p&.00]). 5. The degree of impingement obtained by radiological measurement was 123% in group I and 34% in group lI(statistically significant difference at p=0.001), 6. Accarding to OAK criteria, one cases of group I and 29 cases group II showed excellent result, one case of group I and 3 cases of group II showed poor result. From above results, the presence and degree of impingement assessed by full extension lateral roentgewgram seems to have influence on the stability and clinical result after reconstruction of ACL by one tunnel arthrosccpic technique.