RU2301036C2 - Method for carrying out plastic repair of proper kneecap ligament - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming proper kneecap ligament graft by separating broad rib fascia to transverse canal level to bring it through the canal with transosseous fixation to shortened kneecap ligament.

EFFECT: high reliability in restoring natural ligament length and optimum patello-femoral relation.

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Description

The invention relates to medicine, namely to traumatology and orthopedics.

Known methods of intervention on their own ligament of the patella in congenital pathology of the knee joint. For example, according to V.A. Sturm, a Z-shaped elongation of the patellar ligament is produced.

However, this method is unacceptable with a significant shortening of the latter (see VD Chaklin "Fundamentals of operative orthopedics and traumatology". M: Medicine, 1964-477 p.).

There is a method of restoring the ligament of the patella at its break, for example, according to Kaplan (see N. A. Movshovich "Operational Orthopedics", M .: Medicine, 1994, 446 pp.), Taken as a prototype.

The method consists in excising a free flap from the wide fascia of the thigh, passing it through the thickness of the quadriceps tendon and through the channel drilled in the transverse direction in the tibial tuberosity region, followed by stitching in tension, which ensures the lowering of the patella. The method is designed for cases of injuries when the articular relationships in the knee joint are initially correct, therefore, fixing the flap in the region of the upper pole of the patella is justified.

The disadvantage of this method is its unacceptability for plastic congenital shortened ligament of the patella in children against the background of incipient violations of the congruence of the articular surfaces, since transverse stability of the patella and dynamism during its longitudinal movements are not ensured. In addition, in the free flap of the broad fascia of the thigh, trophism is significantly disrupted, which reduces its elasticity. In this regard, the patient is limited in the range of motion in the knee joint, which leads to a limitation of the function and social maladaptation of a person.

The objective of the proposed invention is the transposition of the patella in the correct physiological position by restoring the length of its own ligament and maintaining optimal intraarticular ratios of the patella-femoral joint and, as a result, improving the function of the knee joint.

The technical result of the task is achieved by the fact that in the method of plasty of the knee ligament of its own, consisting in the formation of a flap - the patellar ligament of its own - from the broad fascia of the thigh, providing the physiological amplitude of the movements of the knee joint, performing the transverse channel in the proximal tibia metaphysis. A flap is proposed — its own ligament of the patella — to be formed by the longitudinal branch of the broad fascia of the thigh to the level of the transverse canal with the possibility of passing it through the canal with transosseal fixation and to the shortened ligament of the patella.

The drawing shows a knee joint (front view) and a plastic diagram of the patellar ligament proper when shortened, where

- position 1 - own ligament of the patella;

- position 2 - patella;

- position 3 - wide fascia of the thigh;

- position 4 - unfree flap of the wide fascia of the thigh;

- position 5 - fibula;

- position 6 - tibia;

- position 7 - channel in the metaphysis of the tibia.

The method is as follows. After dissection of the soft tissues by a cut that envelopes the patella from the outside, its own ligament 1 of the patella 2 is exposed, which is cut off from the attachment site. From the anterior portion of the distal tendon portion of the broad fascia of the thigh 3, a non-free flap 4 is isolated with dimensions of, for example, 12.0 × 1.5 cm without clipping from the fibula 5. In the anterior section of the proximal tibia metaphysis 6, a canal is made in the area of the tuberosity with a 3 mm diameter drill 7 in the transverse direction, through which a flap of the broad fascia of the thigh is passed from the outside to the inside, which is stitched transossally. The patellar ligament is sutured to the formed tendon loop. This ensures the optimal location and direction of the lower traction of the patella, which eliminates its dislocation with complete bending in the knee joint.

The method is technically uncomplicated, rather less traumatic, therefore it can be used in the clinic for treating patients with congenital shortening of the patellar ligament, which will increase the range of motion in the knee joint, improve the function and stability of the knee joint.

Claims (1)

The method of plasty of the patellar ligament of its own, including the formation of a flap from the wide fascia of the thigh, the transverse canal in the tibia, the flap through the canal, characterized in that the flap is formed by the longitudinal part of the wide fascia of the thigh to the level of the canal formed in the proximal metaphysis, the flap is carried out in the channel from the outside to the inside with the formation of a loop and is fixed transosally, a patellar ligament is fixed to the loop.