抄録
Long-term results of simultaneous reconstruction of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using the Leeds-Keio artificial ligament were reviewed. Fif-teen cases were involved and the average follow-up period was 8 years and one month. Supra-condylar fractures of the femur or tibial plateau fractures were combined in four cases, and other ligament injuries in seven cases. Limitation of the range of motion (ROM) was observed in 10 cases. The operation was carried out by arthrotomy and extra-articular stabilization was added. At follow-up, positive Lachman sign was observed in 2 joints (13%), anterior drawer sign in 2 (13%), pivot shift sign in 0 (0%), and posterior drawer sign in 4 (27%) . Limitation of ROM was found in 5 joints (33%), quadriceps atrophy in 11 (73%), and osteoarthritic changes in 9 (60%) . Thirteen cases (87%) experienced pain during activities, and eight (27%) complained of pain in daily life. From the results, a relatively satisfactory stability was obtained with the ACL reconstruction but not with the PCL reconstruction. This is partially because the operative tech-nique had not been established in the first few cases, but there are also several fundamental difficulties in the PCL reconstruction : sharp bending of the running route, difficulty in obtaining sufficient thickness and strength of the substitute, and posteriorly sagging force from gravity. Therefore, further improvement in the PCL reconstruction technique is required in order to achieve better posterior stability with this procedure. In addition, other elements of the clinical results such as limitation of ROM, quadriceps atrophy, osteoarthritic changes and subjective pain, were not as satisfactory as expected. This is mainly because of the severity of this type of injury and also because of high incidence of the combined injuries. However, it is also true that the operative stress onto the joint is much higher with this simultaneous reconstructive procedure than the other ligament reconstructions. Therefore, it was also concluded that operative stress should be minimized in order to improve the outcome of this procedure.
