Preiss A, Giannakos A, Frosch K-H
Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
Oper Orthop Traumatol. 2012 Sep;24(4-5):335-47. doi: 10.1007/s00064-012-0164-9.
Medial collateral ligament reconstruction in chronic unstable knees.
Chronic instability of the medial collateral ligament (MCL) isolated or in combination with multiligament injuries.
Refixable bony avulsions, limited range of motion, arthrofibrosis, severe valgus deformity, infections, critical soft tissue, lack of patient compliance and open growth plates.
Harvesting of the contralateral semitendinosus tendon and preparation. Supine position with leg in electric leg holder. Oblique skin incision above the pes anserinus parallel to the tendons. Placement of drill hole distal to the tibial insertion of the hamstrings in the footprint of the MCL. Tapering and fixation of the transplant. Subfascial tunneling and femoral fixation of the transplant distally to the medial patellofemoral ligament (MPFL) origin in 30° flexion under fluoroscopic control. Tibial fixation of the dorsal portion of the transplant (POL) ventral to the semimembranosus tendon footprint in full extension.
Limited weight bearing with 20 kg for 4-6 weeks, stabilizing brace with limited range of motion 0/0/90°.
A total of 9 patients with a median age of 39 (18-70) years received an augmentation of the MCL complex due to a chronic instability using the described technique. Follow-up examination was performed after 16 (11-56) months. All patients reported a stable knee. The median value of the Lysholm score at follow-up was 90 (72-96) points and the Tegner score prior to trauma was 4 (2-6) points and 3 (2-6) points during follow-up. No grade 2 or 3 instability could be observed during follow-up. There were no complications using the above mentioned technique.
慢性不稳定膝关节的内侧副韧带重建。
内侧副韧带（MCL）慢性不稳定，单独或合并多韧带损伤。
可复位的骨撕脱、活动范围受限、关节纤维性强直、严重外翻畸形、感染、关键软组织损伤、患者依从性差以及生长板未闭合。
取对侧半腱肌腱并进行准备。患者仰卧位，腿部置于电动腿架上。在鹅足上方平行于肌腱做斜行皮肤切口。在MCL足迹处，于腘绳肌腱胫骨附着点远端钻孔。移植肌腱进行锥形处理并固定。在透视控制下于30°屈膝位进行皮下隧道潜行，将移植肌腱远端固定于内侧髌股韧带（MPFL）起点处。在完全伸直位将移植肌腱背侧部分（POL）固定于半膜肌腱足迹腹侧的胫骨上。
4至6周内限制负重20千克，佩戴活动范围受限的稳定支具，活动范围为0/0/90°。
共有9例中位年龄为39岁（18至70岁）的患者因慢性不稳定采用所述技术对MCL复合体进行了增强手术。术后16个月（11至56个月）进行随访检查。所有患者均报告膝关节稳定。随访时Lysholm评分的中位值为90分（72至96分），创伤前Tegner评分为4分（2至6分），随访期间为3分（2至6分）。随访期间未观察到2级或3级不稳定情况。采用上述技术未出现并发症。
