Medial and lateral knee ligament reconstruction

The injury of the medial lateral ligament (anteriorcruciateligament, acl) is a more serious sports injury, and it is not a new disease in the field of orthopedic sports medicine. Due to the high degree of injury and violence, often combined with other major structural injuries, improper diagnosis and treatment will delay the treatment. At the same time, due to the increasing attention paid to the mechanical function of the anterior medial lateral ligament and the functional instability caused by the injury, the knee joint cannot be caused. To meet the needs of daily life and exercise, and can lead to a series of posterior lesions of the knee joint, so surgery should be performed to reconstruct the ligament and its function. The operation of the knee internal and external ligament reconstruction is generally performed. Treatment of diseases: knee ligament injury knee lateral ligament injury Indication 1. The knee collateral ligament is completely broken. 2. In the micro-flexion position of the injured knee joint, the pressure is turned outward, such as the joint joint gap on the X-ray film is greater than the healthy side 10 °. Contraindications 1. Partial fracture of the collateral ligament of the knee joint can be conservatively treated with cast immobilization. 2. Patients with severe heart, lung, liver, kidney disease and diabetes who cannot undergo surgery. Preoperative preparation 1, routine preoperative examination: ECG, chest X-ray, hematuria routine, blood biochemistry, infectious diseases, coagulation function. 2, special examination: knee joint orthotopic, lateral X-ray; knee joint MRI. If necessary, take X-sheet under knee inversion stress, valgus stress, under front drawer stress, and rear drawer stress. 3, common medical examination and treatment: high blood pressure, diabetes, coronary heart disease, thrombotic disease; long-term medication registration. 4. Knee joint function score before surgery in patients with chronic injury. 5. Patient education. Transplant material selection: patellar ligament, national rope tendon, allogeneic tendon, artificial ligament; fixed material selection: can absorb transverse nails and extrusion screws, metal interface screws, and others. 6. Judging the characteristics of the knee: conventional anterior cruciate ligament reconstruction, multiple ligament reconstruction or repair (medial collateral ligament, lateral ligament complex, posterior cruciate ligament), revision, repair with meniscus injury. Surgical procedure 1. Use the arcuate incision on the inside of the knee joint, that is, the incision starts at 2 cm above the medial malleolus of the femur and ends at the inner side of the internal malleolus, about 10 to 12 cm long. 2. Cut the skin and subcutaneous tissue, expose the saphenous vein and the saphenous nerve should be protected, cut the superficial fascia, expose the medial collateral ligament, and gently abduct the knee joint to determine the location of the ligament rupture. Because of the often associated half-month cartilage and cruciate ligament injury, the knee joint is unstable. Therefore, the switch ganglion is cut next to the patellar ligament to explore the half-month cartilage and cruciate ligament. 3. When the broken end of the ligament under the ligament is connected with a large bone mass, the knee is retracted, the bone is reset, and the cancellous bone is used to fix the bone. 4. When there is no bone connection at the broken end of the attachment part under the ligament, a 2cm×1cm bone groove can be made with the bone knife at the ligament attachment part, and two holes are drilled into the bone groove on both sides of the bone groove to pass the thick wire through the bone hole. Pass through the ligament stump and fix it in the bone groove. 5. When the middle part of the ligament is broken, the knee joint is adducted, and the suture overlap suture or U-shaped suture is used to repair. 6. When the attachment part of the ligament is broken, the repairing method is the same as the method of breaking the attachment part under the ligament, usually the U-shaped suture of the broken end or the suture repair of the periosteum flap. 7. Slocum fascia suture method: the old medial collateral ligament is broken. If the posterior horn is relaxed, there is obvious scar tissue. The wide fascia strip with a width of 1cm and a length of 23cm is sutured. The posterior margin of the fascia is first sewed and then behind the humerus. The nodule site is pulled distally, backwards, and proximally to the medial tendon of the semitendinosus and to the posterior border of the medial joint ligament. 8. Through the semi-membrane tendon, try to tighten the fascia strip and bend the knee 30° to check the abduction stress. After the test was normal, the anterior medial heel of the semimembranous muscle was released. 9. The posterior joint capsule and the semi-membrane muscle are sutured straight, pierced from the proximal initial suture, knotted, fixed with silk thread, and the free semi-membrane muscle is sutured to the posterior edge of the joint line and the collateral collateral ligament. . 10. Reconstruction, the temporal ligament and posterior internal joint capsule from the femoral free tissue flap with small bone fragments at the femoral attachment, turned to the distal side. 11. The posterior tibia is pushed, the calf is rotated inward and inversion, and the collateral ligament of the iliac crest is tightened. It is fixed on the posterior horn of the femur with a stab nail. 12. Slightly flex the knee joint, suture the posterolateral medial capsule and the collateral collateral ligament on the posterior margin of the medial femoral muscle. 13. Move the severed goose to the proximal side and suture on the lower margin of the ankle and the tibial tuberosity. 14. After the ligament is repaired, relax the tourniquet, carefully stop the bleeding, rinse the wound, suture the incision layer by layer, and fix the joint with the long leg U-shaped plaster after the dressing at the 5° position of the flexion 30°.

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