Wissing H, Schmit-Neuerburg K P
Unfallchirurgie. 1980;6(2):101-10. doi: 10.1007/BF02589461.
Surgical treatment of ruptured knee ligaments is indicated, when stress roentgenograms reveal medial or lateral laxity of more than 3 degree compared with the uninjured knee. Operation is recommended on the day of injury until 2 weeks after trauma. A medial or lateral parapatellar incision on the side of laxity is used. It extends distally as far as the tibial tubercle and swings posteriorly at a 45 degree angle to the posterior border of the tibia. The skinflap is reflected including all superficial tissues down to the fascia. By this method collateral ligaments and deep capsular structures as well as cartilage, bone and menisci can be inspected. Ligaments and capsular tears are repaired with atraumatic sutures. Special surgical techniques are required to reattach the inferior margin of the posterior capsule to the tibia. Weak and split collateral ligaments or lax capsular structures are reinforced by a simultaneous tendon transfer. After surgery, the joint must be immobilized in 30 degrees of flexion by an articulated toe-to-groin plaster cast, which allows active motion between 20 and 60 degrees of flexion for 6 weeks. After removal of the cast, resistance exercises are necessary to regain stability. No sport is permitted until at least 4 months after surgery. Results in 50 cases revealed full stability of the knee joint and ability to engage in sports in 72% of patients.
