探讨关节镜下反向悬吊固定法治疗膝关节前交叉韧带(ACL)及前外侧结构(ALS)损伤的临床疗效，为术式改进提供依据。

回顾性分析2017年1月至2020年1月中山市中医院收治的膝关节ACL并ALS损伤的患者，关节镜下屈膝位经前内外入路建立胫骨及股骨隧道方式进行ACL单束解剖重建+反向悬吊固定法重建ALS。术前、术后12月、术后18月对患者膝关节功能及旋转稳定性进行疗效评价。使用重复测量方差分析或多样本秩和检验进行统计。

共纳入50例患者，共随访(26±4)个月，术后无神经血管损伤、移植物重建失败等严重并发症。所有患者前抽屉试验、拉赫曼试验均为阴性；运动时膝关节稳定性/急转身转向功能(KSS/CPA)评级为A/A级37例、A/B级8例、B/A级5例；Lysholm评分为由术前的55(35, 61)分提高到术后18月92(91, 94)分，国际膝关节文献编制委员会膝关节评估表(IKDC)评分由术前的55(34, 63)提高到术后18月的92(91, 93)分，多样本秩和检验结果提示患者Lysholm评分、IKDC评分术后均优于术前(Lysholm评分：Z＝95.747；IKDC评分：Z＝95.358；均为P<0.001)，而术后12个月及18个月评分差异均无统计学意义(Lysholm评分：Z＝1.485，校正P＝0.472；IKDC评分：Z＝1.414，校正P＝0.412)。术后随访18月显示5例出现Ⅰ度松弛(10%)。

非共用隧道反向悬吊固定法治疗膝关节前交叉韧带及前外侧结构损伤，更有利于膝关节前向及旋转稳定功能恢复，具有操作简便、植入物张力可单独调节、安全有效等优势。

To investigate the clinical efficacy of reverse suspension fixation in the treatment of the knee anterior cruciate ligament (ACL) and anterolateral structure (ALS) injuries under arthroscopy, and this provide a new basis for surgical improvement.

The patients with ACL and ALS injuries were enrolled in Zhongshan Hospital of Traditional Chinese Medicine from January 2017 to January 2020. Single-bundle ACL reconstructions and reverse suspension fixation ALS reconstructions were performed using the anterior-medial and anterior-lateral approach via knee flexor under arthroscope. The knee function and rotational stability of the patients were evaluated before the surgery, 12 and 18 months after the surgery. The data were compared using the repeated measures analysis or multi-sample rank-sum test.

A total of 50 patients were included for analysis with the follow-up time of (26±4)months, no severe complication such as neurovascular injury or graft reconstruction failure occured. Anterior drawer test and Lachman test were negative in all the patients. The grade of knee stability in sports(KSS)/cutting-pivoting ability (CPA)were A/A(37 cases), A/B(eight cases), B/A(five cases). The Lysholm score was 55(35, 61) before the surgery and increased to postoperative 92 (91, 94) in the post-operative 18 months, and the score of IKDC score was increased from 55 (34, 63) to 92 (91, 93) points in the post-operative 18 months. The Lysholm score and IKDC score of the patients 12 and 18 months after the surgery were better than those before the surgery(Lysholm score: Z=95.747, IKDC score: Z=95.358, both P<0.001), while the difference between 12 and 18 months after the surgery showed no statistically significant(Lysholm score: Z=1.485, adjusted P=0.472; IKDC score: Z=1.414, adjusted P=0.412). After 18 months of follow-up, five patients presented gradeⅠrelaxation (10%).

The surgical procedure for reverse suspension fixation in the treatment of knee ACL and ALS injury via non-shared tunnel may be more conducive to the recovery of the forward and rotation stabilization of knee, which has advantages of simple operation, independent adjustment of implant tension, safety and effectiveness.