Sonnery-Cottet Bertrand, Archbold Pooler, Rezende Fernando C, Neto Ayrton M, Fayard Jean-Marie, Thaunat Mathieu
Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France.
Musgrave Park Hospital, Belfast, Ireland.
Arthrosc Tech. 2014 Jun 9;3(3):e389-92. doi: 10.1016/j.eats.2014.02.009. eCollection 2014 Jun.
Intense interest has focused on the recent description of the anterolateral ligament of the knee. Advancing knowledge of its anatomy and function is leading to a realization of its importance in the rotatory control of the tibia in anterior cruciate ligament injuries. Reconstruction of this structure will increasingly become an important goal during anterior cruciate ligament reconstruction. However, preoperative assessment of this ligament is difficult. Clinical assessment of rotatory laxity has poor reproducibility, and it is difficult to define using current imaging techniques. This article is the first to describe a safe and reproducible arthroscopic technique to allow identification and examination of the anterolateral ligament of the knee. With the knee at 90° of flexion, the arthroscope is introduced through the anterolateral portal to allow clear visualization of the lateral gutter. Under direct vision, an accessory portal is made over the inferior limit of the lateral gutter. A shaver is then introduced through this portal and used to debride this synovial recess and define the anterolateral ligament. This allows the surgeon to examine the integrity of the anterolateral ligament, in particular its femoral insertion. If required, this additional information can facilitate the performance of a more accurate and effective extra-articular reconstruction.
对膝关节前外侧韧带的最新描述引发了人们的浓厚兴趣。对其解剖结构和功能的深入了解，使人们逐渐认识到它在控制前交叉韧带损伤时胫骨旋转方面的重要性。在进行前交叉韧带重建时，重建该结构将越来越成为一个重要目标。然而，术前对这条韧带的评估具有难度。对旋转松弛的临床评估可重复性差，并且利用当前的成像技术难以对其进行界定。本文首次描述了一种安全且可重复的关节镜技术，用于识别和检查膝关节的前外侧韧带。在膝关节屈曲90°时，通过前外侧入路插入关节镜，以便清晰观察外侧沟。在直视下，在外侧沟的下限处制作一个辅助入路。然后通过该入路插入刨削器，用于清理这个滑膜隐窝并界定前外侧韧带。这使外科医生能够检查前外侧韧带的完整性，尤其是其在股骨上的附着点。如果需要，这些额外信息有助于更准确有效地进行关节外重建。
