Pompe van Meerdervoort H F
S Afr Med J. 1979 Jun 2;55(23):942-6.
Since acute surgical repair is vastly superior to any form of reconstructive procedure available, it is extremely important that acute ligamentous injuries of the knee do not go unrecognized. Chronic symptomatic instability after untreated major ligament injury marks "the beginning of the end' for the knee, and reconstruction is indicated. The classical stress tests for knee ligament disruption are generally reliable, and the interested doctor should have little difficulty in accurately diagnosing and classifying acute injuries or chronic instability. The technique of examination and classification of knee instability is described. The techniques of acute repair, as well as of selected reconstructive procedures, are described. Reconstruction for anteromedial subluxation is confined to advancement of the medial collateral ligament and posteromedial capsule as a single cuff, moving its tibial attachment distally and anteriorly. Fascia lata reconstruction is used for repair of anterolateral subluxation. Both these extra-articular anterior reconstructions can, in severe cases, be improved by the addition of a midline procedure, using the patellar tendon as an intra-articular graft. Transfer of the medial head of the gastrocnemius muscle is used for symptomatic posterior subluxation.
由于急性手术修复远比现有的任何重建手术方式优越，因此，膝关节急性韧带损伤不被漏诊极为重要。未治疗的主要韧带损伤后出现的慢性症状性不稳定标志着膝关节“走向终结的开始”，此时需要进行重建手术。经典的膝关节韧带断裂应力试验通常是可靠的，感兴趣的医生准确诊断和分类急性损伤或慢性不稳定应该没有太大困难。本文描述了膝关节不稳定的检查和分类技术。还描述了急性修复技术以及一些选定的重建手术技术。前内侧半脱位的重建仅限于将内侧副韧带和后内侧关节囊作为一个袖套推进，将其胫骨附着点向远侧和前方移动。阔筋膜重建用于修复前外侧半脱位。在严重病例中，这两种关节外前侧重建手术都可以通过增加一个中线手术来改进，使用髌腱作为关节内移植物。腓肠肌内侧头移位用于治疗有症状的后脱位。
