Early repair of anterior cruciate ligament rupture

After the early repair of the cruciate ligament, the knee flexion was 45°, and the long leg cast was fixed for 6-8 weeks. During the fixation period, the quadriceps contracted. After removing the plaster, the knee joint is stretched and flexed to avoid excessive flexion and extension, and the knee joint is protected within 1 year to avoid trauma and excessive load. Treatment of diseases: femoral neck fractures, femoral condyle fractures Indication The indications for early repair of anterior cruciate ligament rupture are still controversial. The results of anterior cruciate ligament repair with avulsion fracture of the tibia or femur are reliable, while the success rate of simple suture with body fracture is very low. Surgical procedure Incision The medial incision of the knee. Starting from 2cm on the humerus, parallel to the inner edge of the humerus, along the iliac crest to the iliac crest. 2. Exposing joint stability structure After cutting the skin and subcutaneous tissue, pay attention to identify and protect the subgingival branch of the saphenous nerve, and cut the anterior medial joint capsule and synovial membrane through the extensor muscle expansion, and do not hurt the anterior horn of the meniscus. Push the tibia outward, flexing the knee joint to expose the joint cavity, and clearing the blood in the joint. Carefully examine the anterior cruciate ligament, femoral condyle, humeral condyle and tibial articular surface, supracondylar sac, meniscus, etc. Use the tip of a hemostat to probe the lesion of the cruciate ligament. 3. Repair anterior cruciate ligament Along the lateral margin of the medial femoral muscle, 5 to 7 cm from the proximal side of the iliac crest, the quadriceps muscle was cut, and the knee flexed more than 90° to facilitate the dislocation of the humerus outward, fully revealing the intercondylar recess and repairing the tear of the ligament. . (1) Repair of the fracture of the femoral condyle attachment point: a longitudinal incision of 3 to 4 cm in length on the lateral side of the lateral femoral condyle, revealing the external femoral condyle, and manually aligning the anterior cross of the femoral condyle Two holes were drilled in the normal attachment portion of the ligament with a spacing of 1 cm and parallel to each other. The ligament ends are sutured with steel wire, and the two ends of the wire are respectively taken out from the two bone holes. When the other ligaments are repaired, the knees are flexed 45° to 50°, and the ligature is fixed on the lateral side of the lateral femoral condyle, and the pedicle fat pad or The synovial tissue covers the surface of the ligament. (2) Repair of tibia attachment point rupture: If the anterior cruciate ligament is torn off from the humeral stop with larger bone fragments, it is fixed with screws after complete reduction. For the avulsion fracture of the old humeral condyle, as long as the bone healing is not achieved, the scar tissue in the fracture can be removed, and the bone is fixed by the reduction screw. Fixed screws should not expose the articular surface to avoid affecting joint activity. It is better to suture with a steel wire when there is no bone or bone. The base of the anterior cruciate ligament is sutured by the Bunnell method, and both ends of the wire pass through two holes on the bone piece. From the inner side of the tibia, two parallel holes are drilled obliquely upward from the joint edge 4 cm, and the base of the depression is exposed. The wire is pulled through the hole to completely reset the bone piece, restore the normal tension of the ligament, and cover the ligament with a pedicled fat pad or synovial tissue. (3) ligament parenchymal rupture repair: at the two ends of the ligament, suture fixation with the Bunnell method, one side of the proximal femoral condyle attachment point is fixed from the upper end of the humerus, and the suture is attached to the side of the tibia from the femur. The sputum is fixed and the suture is covered with a pedicled fat pad. 4. Loosen the tourniquet, completely stop the bleeding, flush the joint cavity with isotonic saline, and suture the incision in turn.

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