Herbort Mirco, Abermann Elisabeth, Feller Julian A, Fink Christian
OCM Klinik München, Steinerstraße 6, 81369, München, Deutschland.
Research Unit für Sportmedizin des Bewegungsapparates und Verletzungsprävention, UMIT, Hall, Österreich.
Oper Orthop Traumatol. 2022 Jun;34(3):231-238. doi: 10.1007/s00064-021-00741-8. Epub 2021 Nov 2.
The goal of the modified Ellison operation as a supplement to a conventional anterior cruciate ligament (ACL) reconstruction is to decrease anterolateral rotational instability of a knee joint after ACL rupture, to improve the stability and prevent ACL re-rupture.
An ACL rupture with high risk of re-rupture (young age, high-performance sport, hyperlaxity, contralateral ACL rupture in history), increased subjective and objective anterolateral rotational instability of the knee after ACL rupture, ACL re-rupture.
Gonarthrosis, additive instabilities (e.g. posterolateral, medial), non-anatomical ACL reconstruction with persistent instability, general contraindications to surgery (e.g. infections), chronic irritation of the knee joint.
Supine position. Mark the typical landmarks. Incision from Gerdy's tubercle extending proximally along the iliotibial tract (ITT) to the lateral collateral ligament (approx. 5 cm). Incise the ITT in the line of its fibers about 10 mm anterior to its posterior border and continue the incision proximally to 5 mm proximal to the LCL. Make a parallel incision 10-12 mm anterior to the first incision. Use sharp subperiosteal dissection to elevate the strip of the ITT from Gerdy's tubercle. Secure the distal end of the ITT strip with a nonabsorbable suture (e.g. FiberWire No. 2, Arthrex, Naples, USA). Expose the LCL and pass the ITT strip deep to the LCL from proximal to distal and back to Gerdy's tubercle. Reattach the distal end of the strip of the ITT to its original position at Gerdy's tubercle with a bone anchor. The defect in the ITT can be closed with an absorbable suture (e.g. Vicryl, Ethicon, USA) in the proximal part. Layered closure.
Knee brace for at least 6 weeks, movement limitation of 0‑0-90° for 6 weeks, 2 weeks 20 kg partial weight bearing.
A total of 36 patients (mean age 18.9 years) with a high risk of ACL re-rupture have been treated with ACL reconstruction and modified Ellison procedure. Follow-up over 2 years. Of the patients 35 returned to the previous sports level, 1 patient suffered a re-rupture, 2 patients had cyclops resection and 1 patient contralateral ACL rupture.
改良埃里森手术作为传统前交叉韧带（ACL）重建的补充，其目的是降低ACL断裂后膝关节的前外侧旋转不稳定，提高稳定性并防止ACL再次断裂。
ACL断裂且再次断裂风险高（年轻、从事高水平运动、关节过度松弛、既往有对侧ACL断裂史），ACL断裂后膝关节主观和客观前外侧旋转不稳定增加，ACL再次断裂。
膝关节骨性关节炎、附加不稳定（如后外侧、内侧）、非解剖学ACL重建且持续不稳定、手术的一般禁忌症（如感染）、膝关节慢性刺激。
仰卧位。标记典型标志。从Gerdy结节开始，沿髂胫束（ITT）向近端延伸至外侧副韧带（约5厘米）做切口。在ITT后缘前方约10毫米处沿其纤维方向切开ITT，并向近端继续切开至外侧副韧带近端5毫米处。在第一个切口前方10 - 12毫米处做平行切口。用锐性骨膜下剥离从Gerdy结节抬起ITT条带。用不可吸收缝线（如美国那不勒斯Arthrex公司的2号FiberWire缝线）固定ITT条带的远端。暴露外侧副韧带，将ITT条带从近端向远端穿过外侧副韧带深部，再回到Gerdy结节。用骨锚将ITT条带的远端重新固定在Gerdy结节的原位置。ITT近端的缺损可用可吸收缝线（如美国Ethicon公司的Vicryl缝线）缝合。分层缝合。
佩戴膝关节支具至少6周，6周内活动范围限制在0 - 0 - 90°，2周内部分负重20千克。
共有36例ACL再次断裂风险高的患者接受了ACL重建和改良埃里森手术（平均年龄18.9岁）。随访超过2年。35例患者恢复到之前的运动水平，1例患者再次断裂，2例患者进行了“独眼巨人”切除术，1例患者对侧ACL断裂。
