Franciozi Carlos E, Mameri Enzo S, Gracitelli Guilherme C, Schumacher Felipe C, Credidio Marcos V, Canuto Sérgio, Kubota Marcelo S
Department of Orthopedics and Traumatology, EPM / UNIFESP, São Paulo, Brazil.
Hospital do Coração (Hcor), São Paulo, Brazil.
Video J Sports Med. 2023 Nov 6;3(6):26350254231195087. doi: 10.1177/26350254231195087. eCollection 2023 Nov-Dec.
While most medial-sided knee injuries can be managed conservatively, high-grade injuries of the posteromedial corner have been reported to have less than optimal outcomes with conservative approaches, resulting in residual valgus and rotational instability. Consensus among experts postulates that treatment should be based on reconstructing both the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL). We present a modified technique of a tibial-sling anatomic MCL reconstruction with a POL limb.
High-grade injuries of the posteromedial corner, specifically injuries with medial joint gapping in extension or grade 3 medial-sided tears.
The MCL is reconstructed with a semitendinosus autograft in a tibial sling, created by converging perpendicular bone tunnels at its anatomic tibial insertion, and fixed to a femoral tunnel in the isometric point just posterior and proximal to the medial epicondyle with the knee at 30° of flexion. That same single femoral tunnel will be shared by the two strands of the semitendinosus graft and a limb of gracilis autograft to reproduce the POL, passed through a tibial tunnel in the posteromedial margin of medial tibial condyle, and fixed in extension.
DISCUSSION/CONCLUSION: As recent evidence suggests that medial reconstruction should be preferred over repair, due to favorable complication and failure rates, we describe a technique that is both anatomic-based, reproducing the 2 main medial knee structures (sMCL, POL), and also cost-saving, with decreased need of fixation devices.
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.
虽然大多数膝关节内侧损伤可以保守治疗，但据报道，后内侧角的高级别损伤采用保守治疗的效果并不理想，会导致残留外翻和旋转不稳定。专家们的共识是，治疗应基于重建浅层内侧副韧带（sMCL）和后斜韧带（POL）。我们介绍一种改良的带POL分支的胫骨吊带解剖型MCL重建技术。
后内侧角的高级别损伤，特别是伸直位时内侧关节间隙增宽或内侧3级撕裂的损伤。
采用半腱肌自体移植物在胫骨吊带上重建MCL，通过在其胫骨解剖学止点处汇聚垂直的骨隧道来创建胫骨吊带，并在膝关节屈曲30°时将其固定于内侧髁上后方等长点处的股骨隧道。半腱肌移植物的两股和股薄肌自体移植物的一个分支将共用同一个股骨隧道以重建POL，该分支穿过内侧胫骨髁后内侧缘的胫骨隧道，并在伸直位固定。
讨论/结论：由于近期证据表明，由于并发症和失败率较低，内侧重建优于修复，我们描述了一种既基于解剖学、能重建膝关节内侧两个主要结构（sMCL、POL），又节省成本、减少固定装置需求的技术。
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，作者已随本提交稿件附上患者的豁免声明或其他书面批准形式以供发表。
