SU1197654A1 - Method of recovery of anterior cruciform ligament of knee joint - Google Patents

Abstract

METHOD FOR RECOVERY anterior cruciate ligament KNEE by forming two channels in the lateral condyle of the femur and the two channels in the epiphysis of the tibia, holding and fixing therein grafts beams, characterized in that in order to provide stability of the tibia in all planes of its movement, is formed the ligament from the posterior-lateral and anterior-medial bundles, tighten and fix the first bundle when the knee joint is bent at a right angle, and the second one is at full extension of the joint.

Description

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The invention relates to medicine, namely to orthopedics and traumatology, and can be used for the surgical treatment of anterior-medial instability of the knee joint.

The aim of the invention is to ensure the stability of the shin in all planes of its movement. ,

The method is carried out as follows. ,

ApTpofoMttp is mediated by a paradigm incision. Produce the maximum B03MO Kifoe flexion of the leg. The area of fixation of the anterior cruciate ligament (ACL) is determined (as far as possible) on the medial surface of the external hip snap. From the back of this area, a canal is laid through the lateral condyle of the femur with an exit 2.5–3 cm above the proximal border of the cartilage cover of the block. The direction of the channels is chosen so that the ligament and the long axis of the femur are 40 °, open up, and the angle between both cruciate ligaments is 60 °.

Parallel to the first channel, a second channel is drilled from the front panel of the fixation system. The plane of both channels and the frontal plane form an angle of 85 ° open toward the front and inside.

Ostun 0.5-0.7 cm medially from tuberoghas fibias over 2.5 cm dissect the periosteum longitudinally and move it aside. From here, two parallel channels are formed with an exit to the front inter-cracker field. Moreover, the outlet of one canal is located at the front border of the ared lutercondilaris auterior, and the opening of the other is bordered by the medial tubercle of the inter-muscular elevation.

A graft of sufficient length through both channels is brought into the joint cavity and is fixed with a bone cleft or transosseous schmopomy in one of the openings of the canals on the thigh. The anterior end of the graft is then passed through the posterior canal, and the posterior end through the anterior canal to the tibia. Thus, PKS is formed, which consists of anterior-medial and posterior-lower-lateral bundles. The shin is bent to a 90 ° angle, the posterior bundle of the graft is tightened and fixed with a bone pin in the exit opening of the canal on the tibia. Then, the lower leg is completely unbendled, the front heap of the graft is tightened and also fixed with a bone pin. Next, layer-by-layer tissue closure is performed. The limb in the fully extended position is immobilized with a circular plaster dressing from the upper third of the thigh to the fingertips for 30 days.

Example. The patient, 29 years old, was admitted with a diagnosis of chronic damage to the medial meniscus in the anterior cruciate ligament of the left knee joint, anteromedial instability. Injury of the left knee joint received 7 months. backwards During the operation, it was discovered that the papacapsular rupture of the medial meniscus and the rupture of the anterior cruciate ligament. The sedative meniscus is paracapsularly excised, the anterior cruciate ligament is restored by the proposed method. With

the maximum possible flexion in the knee joint on the medial surface of the lateral condyle of the femur determined the place of fixation of the proximal end of the ACL. From the back and front of this territory, two parallel channels were laid with an exit 3 cm higher than the cartilage cover of the thigh block. The direction and localization of the canals are chosen so that the ligament and the long axis of the thigh make an angle of 40 °, and the angle between the two cruciform

The links are equal to 60 °. 0.7 cm indent medially from tuberosihes fibiae over 2.5 cm dissected and periosteum pushed aside.

Formed two parallel channels

with access to the front inter-licellar field. The ventral vent is located on the anterior part of the ared lutercondilaris ant., And the dorsal canal on the border with the medial tubercle of the inter-muscular elevation.

The canned tendon was sequentially passed through the channels and anterior-medial and posterior-lateral bundles of the ligament were formed. In the thigh, the tendon is fixed by transosseous mylar spikes. When bending the leg in

the knee joint up to 90 ° is tensioned and the posterior-lower lateral bundle of the ligament is fixed; when extending to 180 °, the anterior medial bundle is tensioned.

The joint is washed with novocaine. Produce layer-by-layer flattening of soft tissues. The operative wound is drained by two rubber bands. The limb is immobilized with a circular plaster cast from the upper third of the thigh to the fingertips in the extension position. On the 14th day you are

stitches. Wound healing by primary tension.

After a month, the gypsum dressing belt has been removed and physiofunctional treatment has been started for the second period. Reached within 11 days

range of motion: active flexion 90 °, extension 180 °. The patient was discharged for outpatient treatment.

When monitored after 11 months. the sick chute does not apply, walks, works in previous posts.

The proposed method of restoring PKS has been applied in 33 patients with anterior-medial instability of the knee vanity3 11976544

va. In the immediate postoperative period, the position of 4-5 mm. In the future (through

There is a rapid recovery in volume of 8 months.) symptom regress is observed

movements (within 7-12 days active "drawer.

extension of 180 °, flexion of 90 °) and sufficient - The method allows to achieve stable

on the stability of the knee joint (symp-j joint stability and reduce the continued “drawer”) in the neutral rehabilitation.

Claims (1)

METHOD FOR RESTORING THE FRONT CROSS CONNECTION KI OF THE KNEE JOINT by forming two channels in the lateral condyle of the femur and two channels in the pineal gland of the tibia, conducting and fixing transplant bundles in them, characterized in that, in order to ensure the stability of the tibia in all planes of its movement, form a ligament from the posterolateral and the anterior-medial bundles, stretch and fix the first bundle when bending the knee joint at right angles, and the second when the joint is fully extended. >