Laupattarakasem Wiroon, Boonard Manusak, Laupattarakasem Pat, Kosuwon Weerachai
Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Arthrosc Tech. 2012 Dec 1;2(1):e1-7. doi: 10.1016/j.eats.2012.09.001. Print 2013 Feb.
The posterior tibial inlay technique is currently accepted as a standard operation for the posterior cruciate ligament-deficient knee. The classical technique requires a graft construct consisting of a bony part to be fitted into the posterior tibial socket. When an autogenous source is chosen, morbidity at the donor site generated by obtaining the graft with a bony part (e.g., bone-patellar tendon-bone or quadriceps tendon-bone) can be more serious than when obtaining the soft-tissue graft (e.g., hamstring). This study describes an alternative use of soft-tissue graft anchored in a bone socket at the posterior tibial margin by a transfixing cancellous screw. The graft is secured on top by a "bone washer" harvested from this bone socket to provide biological bone-tendon-bone healing. The posterior cruciate ligament remnant with integral fibers at the femur can have its tibial part revised, tensioned, and reattached concomitantly. This additional procedure is deemed to enhance joint stability and promote graft healing.
目前，后交叉韧带损伤膝关节的后胫骨镶嵌技术被公认为标准手术。经典技术需要一个由骨部分组成的移植物结构，以适配到后胫骨窝中。当选择自体移植物来源时，获取带有骨部分的移植物（如骨-髌腱-骨或股四头肌肌腱-骨）所导致的供区并发症，可能比获取软组织移植物（如腘绳肌）时更为严重。本研究描述了一种替代方法，即将软组织移植物通过一枚贯穿的松质骨螺钉固定于后胫骨边缘的骨窝中。移植物通过从该骨窝获取的“骨垫圈”固定于上方，以实现生物性骨-肌腱-骨愈合。股骨处带有完整纤维的后交叉韧带残端，其胫骨部分可同时进行翻修、张力调整和重新附着。该附加手术被认为可增强关节稳定性并促进移植物愈合。
