Levy Bruce A, Stuart Michael J, MacDonald Peter B, Marx Robert G, Stannard James P, LaPrade Robert F, Engebretsen Lars, Miller Mark D, Whelan Daniel, Boyd Joel L, Fanelli Gregory C
Instr Course Lect. 2019;68:513-544.
The management of knee ligament injuries continues to evolve, and much debate persists over the timing of surgery, repair versus reconstruction, surgical technique, postoperative rehabilitation, graft selection, and fixation. Surgeons should be aware of updates on the best management strategies of knee ligament injuries in 2018 and understand the important history and physical examination findings of the knee with ligamentous injury; the anterior cruciate ligament; the role of the anterolateral ligament and lateral extra-articular tenodesis; combined anterior cruciate ligament and medial collateral ligament injuries; the posterior cruciate ligament; medial collateral ligament repair versus reconstruction; posterolateral corner repair versus reconstruction; the role of coronal plane osteotomies, including high tibial osteotomy and distal femoral osteotomy; the role of sagittal plane osteotomies, including anterior closing wedge osteotomy and anterior opening wedge osteotomy; the initial management of the multiligament-injured knee; and five keys to avoiding complications in the multiligament-injured knee. The best available evidence and sample case presentations help guide surgical decision making and improve patient outcomes.
膝关节韧带损伤的治疗方法不断发展,关于手术时机、修复与重建、手术技术、术后康复、移植物选择和固定等问题仍存在诸多争议。外科医生应了解2018年膝关节韧带损伤最佳治疗策略的最新进展,并理解膝关节韧带损伤、前交叉韧带损伤的重要病史和体格检查结果;外侧副韧带和外侧关节外固定术的作用;前交叉韧带和内侧副韧带联合损伤;后交叉韧带损伤;内侧副韧带修复与重建;后外侧角修复与重建;冠状面截骨术(包括高位胫骨截骨术和股骨远端截骨术)的作用;矢状面截骨术(包括前闭合楔形截骨术和前开口楔形截骨术)的作用;多韧带损伤膝关节的初始治疗;以及避免多韧带损伤膝关节并发症的五个关键要点。现有最佳证据和样本病例展示有助于指导手术决策并改善患者预后。