Hetsroni Iftach, Mann Gideon
Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.
Arthrosc Tech. 2016 Jun 6;5(3):e579-87. doi: 10.1016/j.eats.2016.02.021. eCollection 2016 Jun.
The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCL-anterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion.
迄今为止，内侧副韧带（MCL）重建唯一的自体移植物选择是半腱肌腱。然而，在合并MCL-前交叉韧带（ACL）损伤的膝关节中，这存在一些潜在缺点，包括在已经存在ACL损伤的膝关节中削弱腘绳肌的前向约束作用，以及在重建过程中保留半腱肌在鹅足的附着点完整时，MCL移植物在远端的非解剖学插入。此外，由于一些外科医生更倾向于使用腘绳肌进行自体ACL重建，如果外科医生偏好自体移植物而非异体移植物，那么需要采集对侧未受伤膝关节的腘绳肌作为MCL重建的移植物来源。我们描述了一种使用同侧股四头肌腱-骨和骨-髌腱-骨自体移植物进行MCL和ACL联合重建的技术。这种MCL重建技术保留了腘绳肌腱，并受益于股骨上骨对骨愈合以及MCL在胫骨远端和近端固定所带来的优势，这种固定方式能紧密重现天然MCL在胫骨的附着点。
