Mhaskar Vikram A, Saggar Rachit
JMVM Sports Injury Centre, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
Department of Orthopaedics, Knee & Shoulder Clinic, F7, East of Kailash, New Delhi, 110065 India.
Indian J Orthop. 2023 Jul 18;57(9):1551-1557. doi: 10.1007/s43465-023-00954-y. eCollection 2023 Sep.
We describe a case of a failed anterior cruciate ligament (ACL) reconstruction that underwent revision surgery. Lachman, anterior drawer and valgus stress tests were all grade 3, indicating ACL and medial collateral ligament (MCL) insufficiency. Posterior tibial slope (PTS) was 18° and coronal alignment was 5° valgus. The PTS and valgus alignment were possible contributing factors to the failure of the ACL reconstruction (ACLR). A novel approach was taken wherein an anterior closing wedge osteotomy (ACWO) and varising osteotomy were done after performing a tibial tuberosity (TT) osteotomy followed by revision ACLR and MCL reconstruction (MCLR). At 2-year follow-up, the coronal alignment changed to 1° varus and the tibial slope to 5°. The Knee Society Score improved from 34 pre-operatively to 90, with the patient returning to weightlifting and pre-injury activity levels.
我们描述了一例接受翻修手术的前交叉韧带（ACL）重建失败病例。拉赫曼试验、前抽屉试验和外翻应力试验均为3级，提示ACL和内侧副韧带（MCL）功能不全。胫骨后倾（PTS）为18°，冠状面成角为5°外翻。PTS和外翻成角可能是ACL重建（ACLR）失败的因素。采用了一种新方法，即在进行胫骨结节（TT）截骨术后，先进行前闭合楔形截骨（ACWO）和内翻截骨，然后进行翻修ACL重建和MCL重建（MCLR）。在2年随访时，冠状面成角变为1°内翻，胫骨后倾变为5°。膝关节协会评分从术前的34分提高到90分，患者恢复了举重及伤前的活动水平。
