Jagtap Satyajeet, Arora Chandan
Government Medical College and Hospital, Nagpur, India.
Arthrosc Tech. 2021 Jan 15;10(2):e333-e339. doi: 10.1016/j.eats.2020.10.014. eCollection 2021 Feb.
Anterior cruciate ligament (ACL) tibial avulsion occurs predominantly in children and young adults. It is seen in association with injuries due to hyperextension usually involving movements that are similar to riding a bicycle. Bony ACL avulsion is associated with severe restriction of knee range of motion, swelling, inability to bear weight, and continuous pain. Acute swelling does not allow a conclusive clinical examination. Bony ACL avulsion from the tibial side has been treated by various methods ranging from conservative management to a wide range of operative procedures. The various operative procedures that have been described require challenging operative skills, time, and resources, making these techniques demanding and technically challenging. We describe a technique for the treatment of Meyers-McKeever type II, III, and IV bony tibial ACL avulsions that uses regular anterolateral and anteromedial portals with an additional transpatellar portal. The avulsed fragments along with the ACL are held and buttressed with the help of FiberWires and fixed with the intra-articular portion of the proximal tibia. The technique is performed in an all-inside manner and is easy to master, even for beginners.
前交叉韧带（ACL）胫骨撕脱伤主要发生于儿童和年轻人。它常与膝关节过度伸展损伤相关，通常涉及类似于骑自行车的动作。骨皮质的ACL撕脱伤会导致膝关节活动范围严重受限、肿胀、无法负重以及持续疼痛。急性肿胀使得无法进行确切的临床检查。从胫骨侧发生的骨皮质ACL撕脱伤已通过多种方法进行治疗，从保守治疗到广泛的手术操作。已描述的各种手术操作需要具有挑战性的手术技巧、时间和资源，使得这些技术要求高且在技术上具有挑战性。我们描述了一种治疗迈耶斯 - 麦基弗（Meyers - McKeever）II型、III型和IV型胫骨骨皮质ACL撕脱伤的技术，该技术使用常规的前外侧和前内侧入路以及一个额外的经髌入路。借助纤维线固定并支撑撕脱的骨块及ACL，并将其固定于胫骨近端的关节内部分。该技术以全关节内方式进行，即使对于初学者也易于掌握。
