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前交叉韧带近端撕裂的解剖学关节镜下一期修复

Anatomic Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears.

作者信息

Rilk Sebastian, Goodhart Gabriel C, O'Brien Robert, Vermeijden Harmen D, van der List Jelle P, DiFelice Gregory S

机构信息

Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.

Medical University of Vienna, Vienna, Austria.

出版信息

Arthrosc Tech. 2023 May 15;12(6):e879-e888. doi: 10.1016/j.eats.2023.02.022. eCollection 2023 Jun.

DOI:10.1016/j.eats.2023.02.022
PMID:37424646
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10323735/
Abstract

Within the last decade, various highly diverse anterior cruciate ligament (ACL) preservation techniques have been proposed, as contemporary selective arthroscopic ACL preservation experienced a resurgence. Among surgical techniques, there are a variety of suturing, fixation, and augmentation methods, whereas a common thread, considering essential anatomic and biomechanical properties, is missing. This technique aims to anatomically reapproximate both the anteromedial (AM) and posterolateral (PL) bundles to their respective femoral footprints. Additionally, a PL compression stitch is performed to increase the ligament-bone contact area and recreate the anatomic vectors of the native bundles, therefore, creating a more anatomic and biomechanical construct. This technique is a minimally invasive procedure, with no graft harvesting nor tunnel drilling, which leads to decreased pain levels, earlier return of full range motion (ROM), and faster rehabilitation, while failure rates seem to be comparable to that of ACL reconstruction. We present an updated surgical technique of anatomic arthroscopic primary repair with suture anchor fixation for patients with proximal ACL tears.

摘要

在过去十年中，随着当代选择性关节镜下前交叉韧带（ACL）保留技术的复兴，人们提出了各种高度多样化的ACL保留技术。在手术技术方面，有多种缝合、固定和增强方法，但考虑到基本的解剖学和生物力学特性，却缺少一条共同的主线。该技术旨在将前内侧（AM）束和后外侧（PL）束在解剖学上重新近似到它们各自的股骨足迹。此外，进行PL压迫缝合以增加韧带-骨接触面积并重建天然束的解剖学向量，从而创建一个更符合解剖学和生物力学的结构。该技术是一种微创手术，无需采集移植物或钻孔，这导致疼痛程度降低、全范围活动（ROM）更早恢复以及康复更快，而失败率似乎与ACL重建相当。我们展示了一种用于近端ACL撕裂患者的采用缝线锚钉固定的解剖学关节镜一期修复的更新手术技术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/36508cfc7e84/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/449b99099660/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/2bb0aebde480/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/f1f9d0081867/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/67fe29dbf74a/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/cb46ae5ff674/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/2ba29bbbe030/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/1589f506f903/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/5899e4377637/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/36508cfc7e84/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/449b99099660/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/2bb0aebde480/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/f1f9d0081867/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/67fe29dbf74a/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/cb46ae5ff674/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/2ba29bbbe030/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/1589f506f903/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/5899e4377637/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b417/10323735/36508cfc7e84/gr9.jpg

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Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient.前交叉韧带（ACL）急性损伤后的管理（下）：ACL 损伤患者的管理。
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