RESUMO
The treatment of posterolateral corner (PLC) knee injuries has always been a challenging topic due to the low healing capacity of PLC injuries. Authors performed posterior cruciate ligament reconstruction using semitendinosus tendon graft and reconstruction procedure of PLC using free gracilis tendon graft with LaPrade technique in a patient with multiple ligament injury of the knee. A 36-years-old male patient complained of pain on his right knee. On physical examination, the posterior drawer test, dial test, and varus stress test were positive. Magnetic resonance imaging (MRI) on right knee showed that the posterior cruciate ligament (PCL), lateral collateral ligament, and popliteofibular ligament were injured but the popliteus tendon was still intact. A semitendinosus tendon was harvested from the ipsilateral pes anserinus region for posterior cruciate ligament reconstruction. Posterolateral corner reconstruction was done by grafting two gracilis tendons from ipsilateral and contralateral sides using LaPrade technique. The semitendinosus tendon graft had been used for PCL reconstruction in some cases besides the hamstring tendon graft and provides a clinically evident reduction in symptoms and restores satisfactory stability. The LaPrade technique for PLC reconstruction was one of the earliest descriptions of a surgical option to recreate the anatomy of the three main static stabilizers of the PLC. We reported a reconstructive procedure for PCL and PLC injury of the knee by using semitendinosus and gracilis tendon graft with LaPrade technique.
RESUMO
Objective: To investigate the method and effectiveness of transosseous suture in situ technique in repairing anterior cruciate ligament (ACL) avulsion injury for the multiple ligament injuries with knee dislocation (MLIKD). Methods: The clinical data of 27 patients (27 knees) with MLIKD between September 2010 and April 2016 were analyzed retrospectively. There were 21 males and 6 females, with an average age of 42 years (range, 24-60 years). The injury was caused by traffic accident in 9 cases, heavy-weight crushing in 9 cases, sports sprain in 6 cases, falling from height in 3 cases. The interval from injury to operation was 1-19 days (mean,10.8 days). There were 20 cases of femoral avulsion injury of ACL, 7 cases of tibial avulsion injury of ACL, and there were 17 cases of posterior cruciate ligament (PCL) injuries. According to the Schenck classification, there were 15 cases of KD-Ⅲ-M type, 8 cases of KD-Ⅲ-L type, and 4 cases of KD-Ⅳ type. All patients were positive in the posterior drawer test and Lachman test; 8 cases were degree Ⅲ positive in varus stress test, and 15 cases were degree Ⅲ positive in valgus stress test. The Lysholm score of knee was 27.6±6.5, the International Knee Documentation Committee (IKDC) score was 25.5±6.2, and the range of motion (ROM) of knee was (45.1±10.2)°. The injured PCL was reconstructed with a single bundle of autologous hamstring tendon. ACL was repaired with double bundle traction by transosseous suture in situ technique. Medial cruciate ligament, lateral cruciate ligament, joint capsule, and other damaged structures were repaired at the same time. Results: All incisions healed by first intention. There were 3 cases with joint effusion and 3 cases with incomplete flexion. All patients were followed up 12-36 months (mean, 22 months). The X-ray films showed good stability in all directions. At last follow-up, the anterior and posterior drawer tests were all negative; Lachman test was degreeⅠpositive in 4 cases, valgus stress test was degreeⅠpositive in 3 cases, varus stress test was degreeⅠpositive in 1 case; and all tests were negative in the rest patients. At 1 year after operation, the ROM of knee was (119.3 ±12.6)°, Lysholm score was 87.2±6.3, and IKDC score was 87.9±6.3, showing significant differences when compared with the preoperative scores ( P<0.05). Conclusion: Transosseous suture in situ technique can be used to repair the ACL avulsion injury for MLIKD, which can significantly improve the stability, mobility and function of the knee joint, and obtain satisfied short-term effectiveness.
RESUMO
Multiple ligament injuries of the knee means more than two ligament injuries, using as an analogue of the knee dislocation. The first priority in the early diagnosis and treatment of the knee dislocation is a vascular evaluation of extremity and careful neurovascular examination should be done firstly. It is common opinion in the treatment of multiple ligament injuries that surgical treatment is superior to conservative treatment. Especially, early ligament repair or reconstruction and aggressive rehabilitation are recommended in young active patients.