Petersen Wolf, Mustafa Hassan Al, Buitenhuis Johannes, Braun Karl, Häner Martin
Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, Berlin, Deutschland.
Oper Orthop Traumatol. 2024 Dec;36(6):363-374. doi: 10.1007/s00064-024-00856-8. Epub 2024 Aug 22.
Replacement of superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with an allograft.
Chronic 3° isolated medial instability and combined anteromedial or posteromedial instability.
Infection, open growth plates, restricted range of motion (less than E/F 0-0-90°).
Longitudinal incision from medial epicondyle to superficial pes anserinus and exposure of the medial collateral ligament complex. Thawing of the allogeneic semitendinosus tendon graft at room temperature, reinforcement of the tendon ends with sutures and preparation of a two-stranded graft. Placement of guidewires in the sMCL and POL insertions and control with image intensifier. Tunnel drilling. Pulling the graft loop into the femoral bone tunnel and fixation with a flip button. Pulling the two graft ends into the tibial tunnels. Tibial fixation by knotting the suture ends in a 20° flexion on the lateral cortex. Suture the tendon bundles to the remaining remnants of the medial collateral ligament complex to adopt the flat structure of the natural medial collateral ligament complex.
Six weeks partial weight-bearing, immediately postoperatively splint in the extended position, after 2 weeks movable knee brace for another 4-6 weeks. Mobility: 4 weeks 0-0-60, 5th and 6th weeks 0-0-90.
From 2015-2021, this surgical procedure was performed in 19 patients (5 women, 14 men, age 34 years). Mean Lysholm score at follow-up after at least 2 years was 89 (76-99) points. In 6 patients, there was restricted range of motion 3 months postoperatively, which resulted in further therapy (3 × systemic cortisone therapy, 3 × arthroscopically supported manipulations under anesthesia).
用同种异体移植物替代浅层内侧副韧带（sMCL）和后斜韧带（POL）。
慢性3°孤立性内侧不稳定以及合并的前内侧或后内侧不稳定。
感染、开放生长板、活动范围受限（小于E/F 0-0-90°）。
从内侧髁到浅鹅足做纵向切口，暴露内侧副韧带复合体。在室温下解冻同种异体半腱肌腱移植物，用缝线加固肌腱两端并制备双股移植物。在内侧副韧带和后斜韧带附着点置入导丝并用影像增强器进行控制。钻孔。将移植物环拉入股骨骨隧道并用翻转纽扣固定。将两根移植物末端拉入胫骨隧道。通过在外侧皮质上以20°屈曲打结缝线末端进行胫骨固定。将肌腱束缝合到内侧副韧带复合体的剩余残端，以采用天然内侧副韧带复合体的扁平结构。
六周部分负重，术后立即在伸直位使用夹板，两周后使用可活动膝关节支具再持续4-6周。活动度：四周0-0-60°，第五和六周0-0-90°。
2015年至2021年，19例患者（5名女性，14名男性，年龄34岁）接受了该手术。至少两年后的随访中，平均Lysholm评分为89（76-99）分。6例患者术后3个月活动范围受限，需要进一步治疗（3次全身皮质类固醇治疗，3次麻醉下关节镜辅助手法治疗）。
