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使用吻合器固定的联合全内置前交叉韧带重建术与胫骨前侧闭合楔形截骨术：手术技术

Combined All-Inside Anterior Cruciate Ligament Reconstruction and Tibial Anterior Closing Wedge Tibial Osteotomy Using Staple Fixation: Surgical Technique.

作者信息

Khilnani Tyler K, Uppstrom Tyler J, Anzillotti Giuseppe, Rizy Morgan, Strickland Sabrina M, Gomoll Andreas H

机构信息

Department of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A.

IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.

出版信息

Arthrosc Tech. 2024 Sep 24;14(3):103262. doi: 10.1016/j.eats.2024.103262. eCollection 2025 Mar.

DOI:10.1016/j.eats.2024.103262
PMID:40207342
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11977140/
Abstract

Failure of anterior cruciate ligament (ACL) reconstruction may be associated with a number of technical, anatomic, and patient-related factors. In particular, increased posterior tibial slope is associated with a greater risk of failure after both primary and revision ACL reconstruction, likely a result of increased load across the ACL graft. Surgical treatment of increased posterior tibial slope most commonly involves an anterior closing-wedge osteotomy of the proximal tibia, which may be performed in a simultaneous or staged fashion with ACL reconstruction. The authors describe a technique for combined, single-stage, all-inside ACL reconstruction and anterior closing-wedge osteotomy using staple fixation. The proposed technique provides adequate fixation of the osteotomy while minimizing hardware interference with the ACL tunnel placement and maximizing proximal femoral bone stock.

摘要

前交叉韧带（ACL）重建失败可能与多种技术、解剖和患者相关因素有关。特别是，胫骨后倾增加与初次和翻修ACL重建术后失败风险增加相关，这可能是ACL移植物上负荷增加的结果。胫骨后倾增加的手术治疗最常见的是近端胫骨前闭合楔形截骨术，可与ACL重建同时或分期进行。作者描述了一种使用钉固定的联合单阶段全关节镜下ACL重建和前闭合楔形截骨术的技术。所提出的技术在使硬件对ACL隧道置入的干扰最小化并使近端股骨骨量最大化的同时，为截骨术提供了充分的固定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/10f6c6ba472a/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/552777f5bdea/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/68e169dbe1b7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/4d0a36b220b1/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/7093163d6dc8/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/d5e14af16adb/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/10f6c6ba472a/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/552777f5bdea/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/68e169dbe1b7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/4d0a36b220b1/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/7093163d6dc8/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/d5e14af16adb/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25a5/11977140/10f6c6ba472a/gr6.jpg

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本文引用的文献

1
Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases.前交叉韧带缺损的 ACL 明显斜率减少可以通过前交叉韧带闭合楔形和内侧开放楔形胫骨高位截骨术实现：76 例早期经验。
Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):1967-1975. doi: 10.1007/s00167-022-06861-3. Epub 2022 Mar 14.
2
An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review.胫骨后倾角度增加与 ACL 重建后移植物失败风险增加相关：一项系统评价。
Knee Surg Sports Traumatol Arthrosc. 2022 Jul;30(7):2377-2387. doi: 10.1007/s00167-022-06888-6. Epub 2022 Feb 6.
3
Current Concepts in Anterior Tibial Closing Wedge Osteotomies for Anterior Cruciate Ligament Deficient Knees.
前交叉韧带损伤膝关节的胫骨前侧闭合楔形截骨术的当前概念
Curr Rev Musculoskelet Med. 2021 Dec;14(6):485-492. doi: 10.1007/s12178-021-09729-0. Epub 2021 Dec 15.
4
Tibial Tubercle Preserving Anterior Closing Wedge Proximal Tibial Osteotomy and ACL Tunnel Bone Grafting for Increased Posterior Tibial Slope in Failed ACL Reconstructions.保留胫骨结节的前侧闭合楔形近端胫骨截骨术及前交叉韧带隧道植骨术用于前交叉韧带重建失败后增加胫骨后倾坡度
Arthrosc Tech. 2021 Sep 8;10(10):e2221-e2228. doi: 10.1016/j.eats.2021.05.026. eCollection 2021 Oct.
5
Tibial Sagittal Slope in Anterior Cruciate Ligament Injury and Treatment.胫骨矢状倾斜在前交叉韧带损伤和治疗中的作用。
J Am Acad Orthop Surg. 2021 Nov 1;29(21):e1045-e1056. doi: 10.5435/JAAOS-D-21-00143.
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Tibial Tubercle-Sparing Anterior Closing Wedge Osteotomy With Cross-Screw Fixation to Correct Pathologic Posterior Tibial Slope.保留胫骨结节的前侧闭合楔形截骨术并采用交叉螺钉固定以纠正病理性胫骨后倾。
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Effect of Slope and Varus Correction High Tibial Osteotomy in the ACL-Deficient and ACL-Reconstructed Knee on Kinematics and ACL Graft Force: A Biomechanical Analysis.胫骨高位截骨术在 ACL 缺失和 ACL 重建膝关节中对坡度和内翻矫正的影响：生物力学分析。
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Am J Sports Med. 2020 Dec;48(14):3478-3485. doi: 10.1177/0363546520966327. Epub 2020 Nov 2.
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Slope-Reducing Tibial Osteotomy Combined With Primary Anterior Cruciate Ligament Reconstruction Produces Improved Knee Stability in Patients With Steep Posterior Tibial Slope, Excessive Anterior Tibial Subluxation in Extension, and Chronic Meniscal Posterior Horn Tears.胫骨截骨术联合前交叉韧带重建术降低胫骨后倾角可改善合并后倾角陡、伸直位胫骨前向半脱位、慢性后角半月板撕裂患者的膝关节稳定性。
Am J Sports Med. 2020 Dec;48(14):3486-3494. doi: 10.1177/0363546520963083. Epub 2020 Oct 28.
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