TR2021014345A2 - DETECTION METHOD OF TENDON GRAFT TO THE TIBIAL TUNNEL WITH &#8220#&MULTIPLE TIBIAL TUNNEL TECHNIQUE (COLLATERAL TUNNEL TECHNIQUE) &#8221#& IN ARTROSCOPIC FRONT CROSS-LIGATE RECONSTRUCTION - Google Patents

Abstract

Arthroscopic anterior cruciate ligament reconstruction is the fixation of the ends of the tendons taken from the muscles with a graft tunnel opened to the distal femur and proximal to the tibia in order to reconstruct the ruptured ligament. In this surgery, many methods are used to fix the tendon to the tibial tunnel. &#8220#&MULTIPLE TIBIAL TUNNEL TECHNIQUE (COLLATERAL TUNNEL TECHNIQUE) In the &#8221#& technique, three tunnels (more tunnels can be opened) are opened in the tibial tunnel to facilitate the fixation of the tendon to the tibia bone and to increase its stability, providing a stable fixation of the graft to the tibia. Stable fixation provided; It provides safe early movement and mobilization of the patient, reduces thigh muscle atrophy, prevents loss of labor by starting the patient's work earlier, and especially helps athletes (such as football players, athletes) to start sports activities in the early period.

Description

DESCRIPTION TENDON GRAFT TO TlBlAL TUNNEL IN ARTROSCOPIC FRONT CROSS-BAG RECONSTRUCTION DETECTION METHOD WITH ”MULTIPLE TIBIAL TUNNEL TECHNIQUE (COLLATERAL TUNNEL TECHNIQUE)" TECHNICAL FIELD: The invention is used in arthroscopic anterior cruciate ligament surgery in the department of orthopedics and traumatology. With the technique that facilitates the fixation of the used tendon to the tibia bone and increases the stability of the fixation. KNOWN STATUS OF THE TECHNIQUE: The anterior cruciate ligament is the most important ligament that provides the stability of the knee. Arthroscopic anterior cruciate bag reconstruction, the ends of the tendons taken from the muscles to reconstruct the broken ligament is to fix it with a graft tunnel opened to the distal and proximal of the medicine. In this surgery, the tendon Many methods are used in the detection of the tibial tunnel. In this surgery (Figure 1), the graft that will enter the tibia Tibia tip (12), non-rupture and non-absorbable graft tensioner to stretch the tendon and aid fixation It is sewn with threads (4). One main tunnel from proximal tibia (2) and femur distal lateral (1) (14,15) The graft (11) is passed through these tunnels. The graft is passed through the outer hole (5) and the inner hole (6) of the tibial tunnel.

The femoral tunnel is then passed through the inner hole (7) and the outer hole (8). Distal femur with loop/button technique (3) It is fixed with the help of. Graft tensioning Threads at the proximal tibia (2), at the tibial end of the graft (12)(4) The graft is stretched with the help of the tibial main tunnel (14) and a bio-absorbable screw (10) of appropriate thickness is inserted into the graft. (11) is compressed into the tunnel. Afterwards, the graft tensioning Threads(4) at the tibial end of the graft (12) are screwed into the tibia bone. (16) is determined by many techniques such as. In the preparation of the graft (Figure 2), the tendon (17) is folded to fit is brought to the thickness. Loop/button implant (9) is attached to the femoral end of the graft (11). Femur of folded mistendon and the ends (12,13) that will enter the tibia are sutured with graft fixing sutures (18) and made ready with graft tensioning threads (4). is brought. The purpose of these determinations is to prevent loosening of the graft (11) from both the femur and the tibia and to prevent the knee to provide a stable fixation. to facilitate the fixation of the tendon (17) to the tibia bone and to increase its stability. In this technique The preparation of the tendon (17) is done in the same way as the standard technique, but additionally as we will explain. suturation should be done. Perpendicular to the tibial end (12) of the graft, medial and lateral to the tendon The 1st tibial tunnel tension thread (19) and the 2nd tibial tunnel tension thread (20) are sutured. Like other techniques, this technique One main tunnel (collateral tunnels) from proximal tibia (2) and distal lateral femur (1) (14,15) In this technique, fixation of the femoral region is like standard fixations and graft with loop/button technique (11) fixed to the femur. After the tibial main tunnel (14) is opened, it enters the main tunnel from the lateral and medial of the tunnel. The first tibial tunnel (21) and the second tibial tunnel (22) (these two tunnels are like the collaterals of a main vessel) are opened. Femoral fixation is made with Ioop (9) by passing it through the main tunnel (14) to the femoral main tunnel (15). In the tibial region graft tension threads (4) coming out of the tibial main tunnel (14), now 1.tibial tunnel tensioners coming out of the 1st tibial tunnel (21) threads (19) and tension threads (20) of the 2nd tibial tunnel coming out of the 2nd tibial tunnel (22) are seen. With graft tensioning threads(4) The graft (11) is stretched in the appropriate position of the knee and the bioabsorbable screw (10) of appropriate thickness is rotated. It is placed in the tibial main tunnel (14). During this placement, the tibial tunnel in the other two tibial tunnels (21,22) Tension ropes (19,20) wrap around the screw and are tightened between tendon, bone and screw. Thus, three different The graft (11) is compressed to the bio-absorbable screw (10) and the bone, thus providing a stable fixation. More Then, these graft tensioning threads (4) and tibial tunnel tensioning threads (19,20) ends are connected with screws or connected to each other. the graft is made more stable. This detection method is currently not available in the literature. This fix is the same It is also used in posterior cruciate ligament reconstruction and fixation of the graft to the bone in other surgeries. can be used.

OBJECTIVE OF THE INVENTION Anterior cruciate ligament injuries are a very common disease in orthopedics and traumatology. Especially It is frequently seen in people who are engaged in sports (football players, athletes). Arthroscopic treatment for this anterior cruciate ligament reconstruction surgery is performed. In these surgeries, the early postoperative movement and mobilization; loss of work force, formation of deep vein thrombosis, muscle atrophy and reduces the occurrence of other complications. To start this early movement and mobilization The graft should be fixed to both the femur and the tibia stable and should not loosen. "MULTI TIBIAL With the TUNNEL TECHNIQUE (COLLATERAL TUNNEL TECHNIQUE)" technique, a stable fixation of the graft in the tibia is achieved. This allows us to start early movement and mobilization more reliably.

The thickness of the graft is very important in these anterior cruciate ligament surgeries. The tendons taken from the area are folded with special techniques and thus the graft becomes thicker. But this While thickening is provided, the length of the graft is shortened, which makes it difficult to fix the graft. is happening. Therefore, many techniques have been developed for tibial region graft fixation. in other techniques only a tibial tunnel is opened and the bioabsorbable screw is stretched with tension threads and the tension threads are attached as screws. tried to be determined by interventions. ”MULTIPLE TIBIAL TUNNEL TECHNIQUE (COLLATERAL TUNNEL TEKNIGI )” technique, three or more tibial tunnels are opened and threads attached to the graft from each tunnel. The graft is stretched from the main tunnel with tension threads and fixed to the main tibial tunnel with a bioabsorbable screw. At the same time, while turning the screw and advancing it from the main tunnel, it is also possible to pull the threads of the two tunnels opened to the main tunnel. It wraps around the screw and provides stability with ropes from 3 tunnels at the same time. Thus, the tibia The graft is determined from the point. In addition, the outer threads of the 3 tunnels are attached to additional implants such as screws. They connect together without the need for use and increase stability without additional implants. provided stable fixation; It provides safe early movement and mobilization of the patient, thigh muscle It reduces the atrophy of the patient and reduces the loss of labor by starting work earlier. It prevents and especially athletes (such as football player, athlete) start sports activities in the early period. is helpful.

EXPLANATION OF THE FIGURES: Figure 1: Coronal plane view of the knee joint in arthroscopic anterior cruciate ligament reconstruction Figure 2: Preparation of the graft Figure 3: ”MULTIPLE TIBIAL TUNNEL TECHNIQUE (COLLATERAL TUNNEL TECHNIQUE i” technique) Coronal plane view of the knee joint in arthroscopic anterior cruciate ligament reconstruction EXPLANATION OF REFERENCES IN THE FIGURES 1. Femur distal lateral 2. tibia proximal 3. Femur Loop Ropes 4. Graft Tensioning Threads . tibial tunnel tooth hole 6. tibial tunnel inner hole 7. femoral tunnel inner hole 8. femoral tunnel tooth hole 9. loop/button Implant . bio absorbable screw 11. graft 12. tibial end of graft 13. femoral end of graft 14. tibial main tunnel . femoral main tunnel 16. screw 17. tendon 18. graft-stabilizing suture 19. 1st tibial tunnel tension cords . 2. Tibial Tunnel Tension Ropes 21. 1st tibial tunnel (1st collateral tunnel) 22. 2nd tibial tunnel (2nd collateral tunnel) DESCRIPTION OF THE INVENTION The anterior cruciate ligament (ACL) is the most important ligament of the knee joint. Due to the rupture of this bond, orthopedics and ACL surgeries are performed in traumatology. In ACL surgery, the tendon (17) removed from the body is It is fixed to the distal lateral (1) and proximal tibia (2) bone of the femur. In this surgery, the femur Many successful techniques are used for fixation to the distal lateral (1). But tibia proximal (2) Although there are many fixation techniques in fixation, the tendon (17) from the proximal tibial (2) the risk of loosening (separating) is high. Both ends of the tendon (17) taken from the body are made with special sewing techniques. the graft is sutured with tension threads (4). These threads are used to stretch the tendons (17) and assist in fixation. is used. In tibial fixation, a tibial main tunnel (14) is opened to the bone and the tendon (17) is attached to this tibial main it is placed inside the tunnel (14). Tendon (17), tibial proximal thanks to absorbable bio-absorbable screws (10) (2) and the bio-absorbable screw (10). The graft tension threads that remain outside of the tendon (17)(4) It is fixed to the bone with screws (16) or other techniques. In this standard technique, a single tibial main tunnel (14) opens. (17) to facilitate its fixation to the proximal tibia (2) and to increase its stability. In this technique, the tendon (17) is prepared in the same way as the standard technique, but additional suturing is done as we will explain. should be done. 1st tibial tunnel from the medial and lateral of the tendon, perpendicular to the tibial end (12) of the graft. The tension thread (19) and the 2nd tibial tunnel tension thread (20) are sutured. In this technique, like other techniques, tibia One main tunnel (14, 15) is opened from the proximal (2) and distal femur (1). femoral region fixation is like standard fixations and graft (11) femurdistal laterale with loop/button technique (1) is fixed. After the tibial main tunnel (14) is opened, it enters the main tunnel from the lateral and medial of the tunnel. Femoral fixation is made with In the tibial region, graft tensioning threads coming out of the tibial main tunnel (14) (4), threads (20) are visible. With the graft tensioning threads (4), the graft (11) is stretched in the appropriate position of the knee and The thick bioabsorbable screw (10) is rotated and placed in the tibial main tunnel (14). This placement During the tibial tunnel tension cords (19,20) in the other two tunnels (21,22) wrap around the screw, tendon, bone and tightened between the screw. Thus, non-absorbable graft-tensioning threads in three separate tunnels (14,21,22) With (4) and tibial tunnel tension threads (19,20), the graft (11) is stabilized by compressing the bioabsorbable screw (10) and the bone. a fixation is achieved. Then these graft tension threads (4) and tibial tunnel tension thread (19,20) ends The graft is made more stable with screws or by connecting to each other. Thanks to this technique, the tibial It provides more stable fixation to the bone. In addition, graft tension threads (4) and tibial tunnel tension threads (19,20) It can be fixed by knotting each other without the need for screws or additional metal implants.

Thanks to this technique, patients can have early mobilization, early knee movement and leg after surgery. load-bearing movement can be made more reliably. Also, the risk of tibial loosening is reduced. In this technique Three different threads (4,19,20) are knotted together, thus eliminating the need for additional metal implant placement. In the following years, additional surgical interventions such as removal of the implant or implant complications are required.

Claims (2)

REQUESTS 1.Bulus is a new surgical fixation method that strengthens the fixation of the graft to the tibia bone in anterior cruciate ligament reconstruction. Its feature: The graft is prepared as in the standard anterior cruciate ligament reconstruction. In addition, perpendicular to the tibial end (12) of the graft, the 1st tibial tunnel tension rope (19) from the medial and lateral of the tendon, and The second tibial tunnel tension cord (20) is sutured. In this technique, like other techniques, the 1st tibial tunnel (21) and the 2nd tibial tunnel, which are opened into the main tunnel from the proximal (2) and femur distal (more tunnels can be opened laterally) and medial, are passed through. The graft (11) is passed from the tibial main tunnel (14) to the femoral main tunnel (15) and femoral fixation is performed with a loop/button implant (9). In the tibial region, graft tensioning threads (4) and tension threads (20) are now seen coming out of the tibial main tunnel (14). The graft (11) is stretched in the appropriate position of the knee with the graft tensioning threads (4) and the bioabsorbable bioabsorbable screw (10) of appropriate thickness is rotated and placed in the tibial main tunnel (14). During this placement, the tibial tunnel tension threads (19,20) in the other two tibial tunnels (21,22) wrap around the screw and are tightened between the tendon, bone and screw. Thus, a stable fixation is ensured by compressing the graft (11) to the bioabsorbable screw (10) and the bone with the non-absorbable non-breaking graft tensioning threads (4) and tibial tunnel tension threads (19,20) in three separate tibial tunnels (14,21,22). With this technique, three different tibial tunnels are opened and the fixation of the graft to the tibia becomes more stable. This fixation can also be used to fix the graft to the bone in posterior cruciate ligament reconstruction and other surgeries.