使用同侧股薄肌腱对前外侧韧带进行微创解剖重建。
Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon.
作者信息
Trinchese Giovanni Felice, Oliva Francesco, Maffulli Nicola
机构信息
Department of Orthopaedics and Traumatology, "San Francesco d'Assisi" Hospital, Oliveto Citra (SA), Italy.
Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy.
出版信息
Muscles Ligaments Tendons J. 2017 Sep 18;7(2):240-246. doi: 10.11138/mltj/2017.7.2.240. eCollection 2017 Apr-Jun.
Abstract
BACKGROUND
There has been much interest in understanding the anatomy and biomechanics of the anterolateral ligament (ALL). Several recon struction procedures have been proposed to correct rotatory instability after Anterior Cruciate Ligament (ACL) and anterolateral soft tissues injuries.
METHODS
We propose a new anatomic minimally invasive ALL reconstruction using the ipsilateral gracilis tendon. Through small skin incisions, the femoral attachment and the tibial insertion of the ALL can be identified, and half tunnels drilled. Then, the neo-ligament can be passed under the fascia lata into the tunnels. Fixation to the tibia is accomplished with a biotenodesis screw, and to the femur with a TightRope RT (Arthrex).
CONCLUSION
This procedure allows to reconstruct in a minimally invasive fashion the ALL in selected patients with chronic anterolateral instability in ACL deficient knees.
LEVEL OF EVIDENCE
V.
摘要
背景
人们对理解前外侧韧带（ALL）的解剖结构和生物力学有着浓厚兴趣。已经提出了几种重建手术来纠正前交叉韧带（ACL）和前外侧软组织损伤后的旋转不稳定。
方法
我们提出一种使用同侧股薄肌腱进行新型解剖微创ALL重建的方法。通过小的皮肤切口，可以识别ALL的股骨附着点和胫骨止点，并钻出半隧道。然后，新韧带可以经阔筋膜下穿过进入隧道。用生物可吸收螺钉固定于胫骨，用TightRope RT（Arthrex）固定于股骨。
结论
该手术能够以微创方式为ACL缺失且存在慢性前外侧不稳定的特定患者重建ALL。
证据级别
V级。
相似文献
1
Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon.使用同侧股薄肌腱对前外侧韧带进行微创解剖重建。
Muscles Ligaments Tendons J. 2017 Sep 18;7(2):240-246. doi: 10.11138/mltj/2017.7.2.240. eCollection 2017 Apr-Jun.
2
An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 2: Anterolateral Ligament Reconstruction Combined With Anterior Cruciate Ligament Reconstruction.前外侧韧带的体外机器人评估，第2部分：前外侧韧带重建联合前交叉韧带重建
Am J Sports Med. 2016 Mar;44(3):593-601. doi: 10.1177/0363546515620183. Epub 2016 Feb 1.
3
Knee Anterolateral Ligament Reconstruction With Knotless Soft Anchor: Shallow Fixation Prevents Tunnel Convergence.使用无结软锚钉进行膝关节前外侧韧带重建：浅固定可防止隧道汇聚。
Arthrosc Tech. 2022 Mar 16;11(4):e511-e516. doi: 10.1016/j.eats.2021.11.024. eCollection 2022 Apr.
4
Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.膝关节前外侧韧带与解剖前交叉韧带联合重建。
Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3151-6. doi: 10.1007/s00167-015-3783-5. Epub 2015 Sep 19.
5
There Are No Kinematic Differences Between Inframeniscal and Suprameniscal Anterolateral Ligament Injury in the Anterior Cruciate Ligament-Deficient Knee.在 ACL 缺失的膝关节中，半月板下和半月板上前外侧韧带损伤在运动学上没有差异。
Am J Sports Med. 2018 Dec;46(14):3391-3399. doi: 10.1177/0363546518803359. Epub 2018 Nov 2.
6
Anterolateral rotatory instability correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft.使用骨-髌腱-骨移植物进行前交叉韧带重建后，前外侧旋转不稳定与隧道位置相关。
World J Orthop. 2017 Dec 18;8(12):913-921. doi: 10.5312/wjo.v8.i12.913.
7
Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury.外侧关节外腱固定术对单纯前交叉韧带损伤的膝关节无效。
Arthroscopy. 2018 Jan;34(1):251-260. doi: 10.1016/j.arthro.2017.08.258. Epub 2017 Nov 2.
8
Anterolateral Knee Extra-articular Stabilizers: A Robotic Study Comparing Anterolateral Ligament Reconstruction and Modified Lemaire Lateral Extra-articular Tenodesis.膝关节前外侧关节外稳定结构：机器人研究比较前外侧韧带重建与改良 Lemaire 外侧关节外腱固定术
Am J Sports Med. 2018 Mar;46(3):607-616. doi: 10.1177/0363546517745268. Epub 2017 Dec 21.
9
Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study.解剖单束前交叉韧带重建中 2 种股骨隧道位置的比较：一项生物力学研究。
Arthroscopy. 2012 Oct;28(10):1481-9. doi: 10.1016/j.arthro.2012.03.019. Epub 2012 Jul 15.
10
Combined Double Bundle Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction.联合双束前交叉韧带重建与前外侧韧带重建
Arthrosc Tech. 2018 Jul 30;7(8):e881-e886. doi: 10.1016/j.eats.2018.04.011. eCollection 2018 Aug.
引用本文的文献
1
Differences in Clinical Outcomes and Rotational Stability Between Anterolateral Ligament Reconstruction and Lemaire Lateral Tenodesis Following Primary Anterior Cruciate Ligament Reconstruction.初次前交叉韧带重建术后前外侧韧带重建与勒梅尔外侧腱固定术在临床结果和旋转稳定性方面的差异。
Arch Bone Jt Surg. 2025;13(7):426-434. doi: 10.22038/ABJS.2025.84170.3826.
2
Lateral meniscal injury without medial meniscal injury indicates the existence of the Segond fracture in ACL-deficient knees.外侧半月板损伤而无内侧半月板损伤提示前交叉韧带损伤的膝关节存在Segond骨折。
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2023 Dec 27;35:59-64. doi: 10.1016/j.asmart.2023.11.004. eCollection 2024 Jan.
3
Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel.采用经股骨隧道的共用肌腱移植物进行关节镜下前交叉韧带（ACL）和前外侧韧带（ALL）重建手术方法的研究与分类进展。
Front Surg. 2023 Dec 22;10:1292530. doi: 10.3389/fsurg.2023.1292530. eCollection 2023.
4
Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in-vitro study.使用同侧股薄肌腱对前外侧韧带进行微创解剖重建：一项体外运动学研究
J Exp Orthop. 2022 Oct 22;9(1):107. doi: 10.1186/s40634-022-00543-2.
5
Sequential damage assessment of the posterolateral complex of the knee joint: a finite element study.膝关节后外侧复合体的序贯损伤评估：一项有限元研究。
J Orthop Surg Res. 2022 Mar 28;17(1):185. doi: 10.1186/s13018-022-03034-3.
6
Ultrastructure and three-dimensional architecture of the anterior cruciate ligament in the knee joints of young and old monkeys.年轻和老年猴子膝关节前交叉韧带的超微结构和三维结构
Med Mol Morphol. 2020 Mar;53(1):7-14. doi: 10.1007/s00795-019-00224-7. Epub 2019 May 18.
本文引用的文献
1
Anterolateral Ligament Reconstruction Technique: An Anatomic-Based Approach.前外侧韧带重建技术：一种基于解剖学的方法。
Arthrosc Tech. 2016 May 9;5(3):e453-7. doi: 10.1016/j.eats.2016.01.032. eCollection 2016 Jun.
2
Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.使用交织腘绳肌腱重建前交叉韧带和前外侧韧带——技术说明
Rev Bras Ortop. 2016 Jul 4;51(4):466-70. doi: 10.1016/j.rboe.2015.08.021. eCollection 2016 Jul-Aug.
3
Anatomic Anterolateral Ligament Reconstruction of the Knee Leads to Overconstraint at Any Fixation Angle.膝关节解剖学前外侧韧带重建在任何固定角度都会导致过度约束。
Am J Sports Med. 2016 Oct;44(10):2546-2556. doi: 10.1177/0363546516652607. Epub 2016 Jul 12.
4
Combined Anterior and Anterolateral Stabilization of the Knee With the Iliotibial Band.采用髂胫束对膝关节进行前侧和前外侧联合稳定术。
Arthrosc Tech. 2016 Mar 14;5(2):e251-6. doi: 10.1016/j.eats.2015.12.004. eCollection 2016 Apr.
5
Muscles, Ligaments and Tendons Journal - Basic principles and recommendations in clinical and field Science Research: 2016 Update.《肌肉、韧带和肌腱杂志》——临床与现场科学研究的基本原理及建议：2016年更新版
Muscles Ligaments Tendons J. 2016 May 19;6(1):1-5. doi: 10.11138/mltj/2016.6.1.001. eCollection 2016 Jan-Mar.
6
Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury.前交叉韧带损伤情况下的微创前外侧韧带重建
Arthrosc Tech. 2016 Feb 29;5(1):e211-5. doi: 10.1016/j.eats.2015.11.005. eCollection 2016 Feb.
7
Effects of different femoral tunnel positions on tension changes in anterolateral ligament reconstruction.不同股骨隧道位置对前外侧韧带重建中张力变化的影响
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1272-1278. doi: 10.1007/s00167-016-4178-y. Epub 2016 May 25.
8
Cadaveric Study Comparing the Biomechanical Properties of Grafts Used for Knee Anterolateral Ligament Reconstruction.尸体研究：比较用于膝关节前外侧韧带重建的移植物的生物力学特性
Arthroscopy. 2016 Nov;32(11):2288-2294. doi: 10.1016/j.arthro.2016.03.004. Epub 2016 May 7.
9
Isometric Characteristics of the Anterolateral Ligament of the Knee: A Cadaveric Navigation Study.膝关节前外侧韧带的等长特性：一项尸体导航研究。
Arthroscopy. 2016 Oct;32(10):2017-2024. doi: 10.1016/j.arthro.2016.02.007. Epub 2016 May 4.
10
Biomechanical study of strength and stiffness of the knee anterolateral ligament.膝前外侧韧带强度与刚度的生物力学研究
BMC Musculoskelet Disord. 2016 Apr 30;17:193. doi: 10.1186/s12891-016-1052-5.
Zotero 插件