Röhm Julian, Devitt Brian M, Feller Julian A
OrthoSport Victoria, Melbourne, Victoria, Australia.
Kantonsspital Baselland, Bruderholz, Switzerland.
Video J Sports Med. 2023 Sep 11;3(5):26350254231191143. doi: 10.1177/26350254231191143. eCollection 2023 Sep-Oct.
Anterior cruciate ligament (ACL) rupture is an increasingly common injury in the young population. Unfortunately, reinjury rates in this population following ACL reconstruction (ACLR) are also very high. As such, lateral extra-articular procedures have been proposed to augment ACLR and shown to reduce reinjury rates. Most techniques use a strip of iliotibial band (ITB) fixed proximally on the distal femur in close proximity to the lateral femoral epicondyle, which in the skeletally immature patient may be closely associated with the distal femoral physis. In addition, there is also a risk of convergence with the femoral tunnel for the ACLR. The modified Ellison technique avoids both of these risks given it is a distally based tenodesis with its fixation point on the proximal tibial epiphysis. The purpose of this video is to describe a modified Ellison technique in a skeletally immature patient.
Primary ACLR in skeletally immature patients at high risk of ACL graft rerupture due to their young age, a positive family history of ACL rupture in a first-degree relative, previous contra-lateral ACL rupture, generalized joint hypermobility, high-grade pivot-shift test, and participating in pivoting sports.
The modified Ellison technique is a distally based lateral extra-articular procedure. A 1-cm strip of ITB is detached from Gerdy's tubercle, passed beneath the lateral collateral ligament, and reattached back to from where it was removed. The fixation is within the proximal epiphysis of the tibia.
In a high-risk adult population, the modified Ellison technique has been shown to have a low ACL graft reinjury rate at 2 years following an ACLR. Biomechanical studies have demonstrated that a modified Ellison technique closely restores native knee kinematics following simulated anterolateral complex injury.
DISCUSSION/CONCLUSION: The modified Ellison technique is a safe and reproducible lateral extra-articular procedure in skeletally immature patients when performed in combination with an ACLR.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
前交叉韧带（ACL）断裂在年轻人群中越来越常见。不幸的是，该人群在接受ACL重建术（ACLR）后的再损伤率也非常高。因此，有人提出采用外侧关节外手术来加强ACLR，并已证明可降低再损伤率。大多数技术使用一条髂胫束（ITB），近端固定在股骨远端靠近外侧股骨髁处，而在骨骼未成熟的患者中，此处可能与股骨远端骨骺紧密相关。此外，与ACLR的股骨隧道也存在汇聚风险。改良的埃里森技术避免了这两种风险，因为它是一种基于远端的腱固定术，固定点位于胫骨近端骨骺。本视频的目的是描述在骨骼未成熟患者中应用改良埃里森技术的方法。
因年龄小、一级亲属有ACL断裂的阳性家族史、既往对侧ACL断裂、全身关节活动度过大、高级别轴移试验阳性以及参与旋转运动而有ACL移植物再断裂高风险的骨骼未成熟患者的初次ACLR。
改良的埃里森技术是一种基于远端的外侧关节外手术。从Gerdy结节处取下一条1厘米宽的ITB，从外侧副韧带下方穿过，然后重新固定回其取下的位置。固定点位于胫骨近端骨骺内。
在高风险成年人群中，改良的埃里森技术已被证明在ACLR后2年时ACL移植物再损伤率较低。生物力学研究表明，改良的埃里森技术在模拟前外侧复合体损伤后能密切恢复膝关节的自然运动学。
讨论/结论：改良的埃里森技术与ACLR联合应用于骨骼未成熟患者时，是一种安全且可重复的外侧关节外手术。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式，以供发表。
