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带蒂前交叉韧带与前外侧韧带联合重建——“PAAR”技术

Combined, Pedicled Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction - "PAAR" Technique.

作者信息

Wodziński Piotr, Żóraw Tomasz, Patkowski Mateusz

机构信息

Department of Orthopedics, ORTHOS Hospital-LuxMed Group, Komorowice, Poland.

出版信息

Arthrosc Tech. 2024 Jun 9;13(10):103065. doi: 10.1016/j.eats.2024.103065. eCollection 2024 Oct.

DOI:10.1016/j.eats.2024.103065
PMID:39479026
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11519854/
Abstract

Despite constant development of surgical implants, instruments, and rehabilitation protocols, the outcomes of anterior cruciate ligament reconstruction remain unpredictable, and the failure rate of isolated procedures remains unacceptably high. Several factors possibly concerning suboptimal outcomes and risk of graft rerupture have been highlighted, among which are graft healing, tunnel position, and residual rotational instability. Recent studies have suggested that addressing anterolateral complex injury and enhancing graft healing properties might improve the outcomes of surgery. We propose a simple technique of combined anterior cruciate ligament and anterolateral ligament reconstruction using pedicled semitendinosus and gracilis tendons with a single femoral tunnel and no additional tibial tunnels.

摘要

尽管手术植入物、器械和康复方案不断发展，但前交叉韧带重建的结果仍然不可预测，单纯手术的失败率仍然高得令人无法接受。已经强调了几个可能与不理想的结果和移植物再破裂风险有关的因素，其中包括移植物愈合、隧道位置和残余旋转不稳定。最近的研究表明，解决前外侧复合体损伤并增强移植物愈合特性可能会改善手术结果。我们提出一种简单的技术，使用带蒂半腱肌和股薄肌腱，通过单个股骨隧道且无需额外的胫骨隧道，联合重建前交叉韧带和前外侧韧带。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/063bf1232ccd/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/1555ba312244/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/ba62352c1f2f/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/a08584a43734/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/e90f2b5070da/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/0b365146cce7/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/a33e33e18ab9/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/85726be5877e/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/bb4857ad2ba4/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/533770d1c57e/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/063bf1232ccd/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/1555ba312244/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/ba62352c1f2f/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/a08584a43734/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/e90f2b5070da/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/0b365146cce7/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/a33e33e18ab9/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/85726be5877e/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/bb4857ad2ba4/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/533770d1c57e/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c69a/11519854/063bf1232ccd/gr10.jpg

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本文引用的文献

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The Iliotibial Band is the Main Secondary Stabilizer for Anterolateral Rotatory Instability and both a Lemaire Tenodesis and Anterolateral Ligament Reconstruction Can Restore Native Knee Kinematics in the Anterior Cruciate Ligament Reconstructed Knee: A Systematic Review of Biomechanical Cadaveric Studies.髂胫束是前外侧旋转不稳定的主要次要稳定结构，Lemaire 肌腱固定术和前外侧韧带重建术都可以恢复前交叉韧带重建膝关节的正常膝关节运动学：生物力学尸体研究的系统评价。
Arthroscopy. 2024 Feb;40(2):632-647.e1. doi: 10.1016/j.arthro.2023.05.005. Epub 2023 May 18.
2
Preserving the hamstring tendon insertion during ACL reconstruction with an autograft: Systematic literature review.前交叉韧带重建术中自体移植物保留腘绳肌腱止点：系统文献回顾。
Orthop Traumatol Surg Res. 2023 Oct;109(6):103556. doi: 10.1016/j.otsr.2023.103556. Epub 2023 Jan 20.
3
Combined Lateral Extra-Articular Tenodesis or Combined Anterolateral Ligament Reconstruction and Anterior Cruciate Ligament Reconstruction Improves Outcomes Compared to Isolated Reconstruction for Anterior Cruciate Ligament Tear: A Network Meta-analysis of Randomized Controlled Trials.与单纯前交叉韧带撕裂重建相比，联合外侧关节外肌腱固定术或联合前外侧韧带重建与前交叉韧带重建可改善治疗效果：一项随机对照试验的网状荟萃分析。
Arthroscopy. 2023 Mar;39(3):758-776.e10. doi: 10.1016/j.arthro.2022.11.032. Epub 2022 Dec 8.
4
Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group.2018 例 SANTI 研究组患者的匹配对分析：前交叉韧带和前外侧韧带重建联合与单独前交叉韧带重建（骨-髌腱-骨移植物）的临床结果。
Am J Sports Med. 2022 Nov;50(13):3493-3501. doi: 10.1177/03635465221128261. Epub 2022 Oct 18.
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Arthroscopy. 2023 Feb;39(2):308-319. doi: 10.1016/j.arthro.2022.06.039. Epub 2022 Jul 15.
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Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1818-1827. doi: 10.1007/s00167-021-06746-x. Epub 2021 Oct 1.
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Arthroscopy. 2022 Mar;38(3):860-869. doi: 10.1016/j.arthro.2021.05.028. Epub 2021 May 27.
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