RU2181570C2 - Method for treating anteroexterior rotation instability of the knee joint - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves moving the cut off distal tendon of the musculus biceps femoris with bone facet through canal formed under external head of the musculus gastrocnemius and fixing it to fibular head. EFFECT: enhanced effectiveness of treatment. 1 dwg

Description

 The invention relates to medicine, namely to orthopedics traumatology, and can be used in the treatment of anterior-external rotational instability of the knee joint caused by a one-time damage to the anterior cruciate ligament, the posterolateral part of the capsule, the popliteal muscle, the arched ligament of the knee joint.

 Known methods for treating anterior-external rotational instability of the knee include sequential methods of surgery aimed at eliminating each component of instability (front instability [1, 2], rotational instability [3]) in stages, which lengthens the time of surgery and increases the amount of surgical injury .

 Known methods for extra-articular external reconstruction of the anterior cruciate ligament [3] are distinguished by using a portion of the ileotibial tract in the form of a tape to stabilize the knee joint. However, the results of surgical interventions in the form of residual instability, limitation of the flexion-extensor function of the joint make us look for more promising methods of treatment.

 The closest in technical solution to the claimed method is the transposition anteriorly and downward to the tibia of the site of attachment of the biceps femoris and the external lateral ligament of the knee joint with a bone fragment of the head of the fibula [2]. However, this method solves only part of the problem. In this case, the front instability is not eliminated.

 The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, namely, the simultaneous elimination of all components of the anterior-external rotational instability of the knee joint, improving treatment results.

 This is achieved by forming a channel under the lateral head of the gastrocnemius muscle in its proximal section, directed from top to bottom, back to front, from inside to outside, through which the cut tendon of the biceps femoris muscle with the bone facet is passed and the bone facet is reformed.

 The location of the anatomical formations after the operation according to the proposed method is shown in the drawing, which shows the distal head of the biceps femoris 1, lateral head of the calf muscle 2, fibula 3, retainer of the reformed facet of the head of the fibula 4, femur 5, patella 6, tibia 7 .

 The method is as follows.

An external longitudinal incision is made of the skin and fascia along the posterior edge of the contoured tendon of the biceps femoris from the lower third of the thigh to the head of the fibula. The tendon of the biceps femoris muscle is disinfected with the bone facet of the head of the fibula, and the distal part of the tendon is mobilized. When the knee joint is bent, a channel is formed behind the proximal lateral head of the gastrocnemius muscle from top to bottom, from back to front, from the inside out. The cut off end of the tendon of the biceps femoris muscle is passed through the formed channel. Bone facet is refixed with a biceps tendon by one of the known methods (for example, by a screw) to its bed on the head of the fibula. After suturing the postoperative wound, the limb is immobilized with a plaster cast in the position of the external rotation of the lower leg and flexion of the knee joint at an angle of 150 ^o . Two weeks after removal of skin sutures, the lower leg from the external rotation position is transferred to a neutral position with an extension of the immobilization period for another 4 weeks.

 Thus, the dynamic stabilizing effect is achieved by the action of the intersecting tendons of the biceps femoris and the external head of the calf muscle. During extension of the lower leg, the head of the gastrocnemius muscle exerts pressure on the tendon of the biceps femoris muscle, enhancing its outward rotation function with an additional moment stabilizing the anterior displacement of the lower leg.

 An example of the application of the treatment method.

 Sick M-in. Born 1955 (source bol. 240/20325). The SRTT "WTO" entered 1.01.99 with a diagnosis of chronic anteroposterior rotational instability of the right knee joint. In view of the expressed instability and inability of the limb, the patient walks only on crutches. 01/26/99, the operation was performed according to the proposed method. From the external incision in the lower third of the thigh, knee joint and upper third of the lower leg, the tendon of the biceps femoris was transposed through the channel formed under the outer head of the calf muscle. After 6 weeks, he was hospitalized for rehabilitation treatment. Re-examined after 8 months. The patient is satisfied with the result of the operation. Active, uses the wand. The range of motion in the joint is within normal limits. When walking, active tension of the periarticular muscles of the joint does not indicate instability.

Sources of information:
1. Clin Orthop. Relat. Res., 1983, v. 172, p. 85-89.

 2. J. Bone Joint Surq [Am], 3, May 1988, p. 407-411.

 3. Trillat A. Sports injuries, Sofia, 1986, 121, adj. 27.

Claims (1)

 A method of treating anterior-external rotational instability of the knee joint, including cutting off the distal tendon of the biceps muscle with a bone facet from the head of the fibula with its subsequent fixation, characterized in that they form a channel under the lateral head of the calf muscle in its proximal section, directed from top to bottom, back to front , from the inside out, through which the cut tendon of the biceps femoris muscle with the bone facet is carried out and the bone facet is reformed.