Lee Joon Kyu, Lee Sahnghoon, Seong Sang Cheol, Lee Myung Chul
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. E-mail address for M.C. Lee:
JBJS Essent Surg Tech. 2014 Aug 13;4(3):e15. doi: 10.2106/JBJS.ST.N.00078. eCollection 2014 Sep.
The modified transtibial technique with quadriceps tendon autograft allows anatomic anterior cruciate ligament (ACL) reconstruction without tunnel widening and results in a stable and functional knee with a satisfactory clinical outcome.
STEP 1 PREPARE THE PATIENT: Prepare the patient under spinal anesthesia with the usual arthroscopic setting.
STEP 2 ARTHROSCOPIC EXAMINATION: Perform arthroscopic examination to confirm the ACL rupture and other intra-articular lesions.
STEP 3 HARVEST THE QUADRICEPS TENDON: .
STEP 4 PREPARE THE QUADRICEPS TENDON GRAFT: Prepare the quadriceps tendon graft to pass smoothly through the tunnels.
STEP 5 SET THE TIBIAL TUNNEL ENTRY POINT: Make a 3-cm longitudinal skin incision at the anteromedial aspect of the proximal part of the tibia.
STEP 6 CREATE THE TIBIAL TUNNEL: Drill a 10-mm tibial tunnel.
STEP 7 TARGET THE FEMORAL TUNNEL STARTING POINT: Aim the guide at the lateral bifurcate ridge on the medial wall of the lateral femoral condyle with the modified transtibial technique.
STEP 8 CREATE THE FEMORAL TUNNEL: Drill a 10-mm femoral tunnel.
STEP 9 FIX THE GRAFT: Fix the graft with adequate tension.
STEP 10 POSTOPERATIVE REHABILITATION: Rehabilitate the patient step by step.
In a study that compared fifty-two patients managed with a modified transtibial technique and another fifty-two patients managed with an anteromedial transportal technique, there were no significant differences in the clinical results in terms of manual laxity, arthrometric analysis, and subjective outcome.IndicationsContraindicationsPitfalls & Challenges.
采用股四头肌肌腱自体移植的改良经胫骨技术可实现解剖学前交叉韧带（ACL）重建，且不会导致隧道增宽，能使膝关节稳定且功能良好，临床效果令人满意。
步骤1 患者准备：在脊髓麻醉下，按照常规关节镜检查设置准备患者。
步骤2 关节镜检查：进行关节镜检查以确认ACL断裂及其他关节内病变。
步骤3 采集股四头肌肌腱：
步骤4 准备股四头肌肌腱移植物：准备股四头肌肌腱移植物，使其能顺利通过隧道。
步骤5 确定胫骨隧道入口点：在胫骨近端前内侧做一个3厘米的纵向皮肤切口。
步骤6 创建胫骨隧道：钻一个10毫米的胫骨隧道。
步骤7 确定股骨隧道起始点：采用改良经胫骨技术，将导向器对准外侧股骨髁内侧壁的外侧分叉嵴。
步骤8 创建股骨隧道：钻一个10毫米的股骨隧道。
步骤9 固定移植物：以适当张力固定移植物。
步骤10 术后康复：逐步对患者进行康复治疗。
在一项比较52例采用改良经胫骨技术治疗的患者和另外52例采用前内侧入路技术治疗的患者的研究中，在手动松弛度、关节测量分析和主观结果方面，临床结果无显著差异。适应症、禁忌症、陷阱与挑战。
