Moreira da Silva Andre Giardino, Gobbi Riccardo Gomes, Bonadio Marcelo Batista, Angelini Fabio Janson, Pécora José Ricardo, Helito Camilo Partezani
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Hospital Sírio Libanês, São Paulo, Brazil.
Video J Sports Med. 2023 Nov 6;3(6):26350254231195376. doi: 10.1177/26350254231195376. eCollection 2023 Nov-Dec.
Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries and, when they occur in isolation, they often progress with satisfactory outcomes using conservative treatment. However, MCL lesions associated with anterior cruciate ligament or posterior cruciate ligament (PCL) injuries in knee dislocations should be reconstructed to prevent failure of the central pivot. In knees with combined injuries involving the PCL and the MCL, the confluence of tunnels in the medial femoral condyle can be a potential problem during reconstruction surgery.
The indication of this technique is the combined injury of the PCL and the MCL.
The technique consists in the reconstruction of the PCL and the MCL with an Achilles tendon allograft. The bone plug of the graft is fixed on the tibial bed with the inlay technique. The graft passes through a single femoral tunnel drilled in the medial femoral condyle, with entrance point on the footprint of the PCL on the inner wall of the condyle and exit on the origin of the native MCL, near to the medial epicondyle. The graft is fixed in the femoral tunnel with an interference screw and continues to the isometric point of the anatomic insertion of the MCL in the tibia, where an interference screw is used to fix it.
Results from our group using this technique have shown good clinical outcomes, with complications and failure rates similar to other series in the literature.
DISCUSSION/CONCLUSION: This technique is an excellent option for surgeons, when an Achilles tendon allograft is available, to avoid confluence of tunnels in the medial femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion.
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.
内侧副韧带（MCL）损伤是最常见的膝关节韧带损伤，当单独发生时，采用保守治疗通常能取得满意的恢复效果。然而，膝关节脱位时伴有前交叉韧带或后交叉韧带（PCL）损伤的MCL损伤，应进行重建以防止中央枢轴失效。在同时累及PCL和MCL的膝关节损伤中，股骨内侧髁隧道的汇合在重建手术中可能是一个潜在问题。
本技术的适应证为PCL和MCL的联合损伤。
该技术采用跟腱同种异体移植物重建PCL和MCL。移植物的骨栓采用镶嵌技术固定于胫骨床。移植物通过在股骨内侧髁钻出的单个股骨隧道，入口位于髁内壁PCL的足迹处，出口位于原生MCL的起点，靠近内侧髁上。移植物通过干涉螺钉固定在股骨隧道内，并延伸至MCL在胫骨上解剖学插入点的等长点，在此处使用干涉螺钉进行固定。
我们团队使用该技术的结果显示出良好的临床效果，并发症和失败率与文献中的其他系列相似。
讨论/结论：对于有跟腱同种异体移植物可用的外科医生来说，该技术是避免股骨内侧髁隧道汇合的极佳选择。它具有良好的效果和可接受的并发症发生率，与该损伤的严重程度相符。
作者证明已获得本出版物中出现的任何患者的同意。如果个人可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
Zotero 插件