RU2347541C1 - Method for surgical treatment of old rupture of front cruciform ligament of knee joint - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: tendons of semitendinous and tender muscles are separated from place of attachment on tibia. They are cut proximally from muscle bellies. The latter are fixed between each other and sutured to tailor's muscle. Arthroscope is inserted in joint, joint inspection is carried out. Bone channels are formed in tibia and thigh bones. Transplant consisting of tendons of semitendinous and tender muscles sutured to each other is passed through channels. Formation of channels, transplant passing and tensioning are monitored by videoarthroscopic equipment. Transplant end id fixed to periosteum of thigh bone by screw.

EFFECT: lower traumatisation of tissues, provision of stability in joint.

1 ex, 7 dwg

Description

The invention relates to medicine and relates to methods for surgical treatment of diseases and consequences of injuries of the musculoskeletal system, in particular the anterior cruciate ligament of the knee joint.

A known method of surgical treatment of rupture of the anterior cruciate ligament of the knee joint: a feature of the method is the use of semitendinosus muscle for plastic surgery of the anterior cruciate ligament of the tendon (1).

The disadvantage of this method is the high morbidity of surgical intervention, the duration of rehabilitation, a high number of complications.

There is also known a method for surgical treatment of rupture of the anterior cruciate ligament of the knee joint: a feature of the method is that a skin incision of about 2-3 cm is performed in the projection of fixation of the tendons of the tender and semi-tendon muscles to the tibia. The tendons of the tender and semi-tendon muscles are isolated subcutaneously with a special tool, they are proximally cut off from the muscle abdomen, removed to the wound, cut off from the point of attachment to the tibia, and sutured together. Under the control of video arthroscopic technique, bone tunnels are formed with a special drill in the inner condyle of the tibia and the outer condyle of the femur. A cross-linked free transplant is performed under the control of an arthroscope sequentially through the tunnels of the tibia and femur. The ends of the graft in a tight position are fixed with screws to the tibia and femur (2).

The disadvantage of this method is the use of a free transplant with fixing its ends with screws, which increases the invasiveness of the operation. The lack of a feeding leg of the graft slows down its restructuring. Muscular abdomen of the tender and semi-tendon muscles atrophy without their fixation, which reduces the strength of the hip flexors - active stabilizers of the knee joint.

The aim of the invention is to reduce the morbidity during the restoration of a torn anterior cruciate ligament, reducing the number of complications.

This goal is achieved by the fact that the tendons of the semi-tendon and tender muscles are cut off at the transition to the muscle abdomen, and the muscle abdomen of these muscles are sutured to the tailor muscle, the isolated tendons are sutured together and inserted into the formed channels in the tibia and femur, the free end of the graft is fixed with a screw to the femur.

Comparison of the proposed method with other known in the field of medicine shows its compliance with the image criteria.

The graphic image of figure 1 shows the first stage of the operation - the allocation of semi-tendonous and tender muscles; figure 2 - hemming of muscle abdomen to m. sartorius; figure 3 - the removal of the graft into the wound on the lower leg; figure 4 - revision of the joint using arthroscopic techniques; figure 5 - the formation of tunnels in the inner condyle of the tibia and the outer condyle of the femur under the control of arthroscopic technique; 6 - conducting autograft through the formed tunnels; Fig.7 - fixation of the graft to the femur with a screw.

The method is as follows: a skin incision is made on the anteromedial surface of the upper third of the leg about 2-3 cm, at the level of the anatomical attachment of the tendons of the semi-tendon 1 and tender 2 muscles. Tendons of the semi-tendon 1 and tender 2 muscles are isolated using a special tenor, cut them off proximally at the transition to muscle abdomen 3 and 4 (Fig. 1). Muscle abdomens 3 and 4 of these muscles are sutured together and sutured from an additional incision on the thigh to 2-3 cm to m. Sartorius 5 (FIG. 2). The wound on the thigh is sutured. Tendons are held by a clamp 6, removed to the wound on the lower legs and stitched together (Fig.3). Arthroscope 7 is introduced into the joint from standard injections, the joint is revised (Fig. 4). The remains of the stump of the anterior cruciate ligament are removed using a shaver. The lower leg is bent at an angle of 90 degrees. With an awl 8 or drill, a bone tunnel 9 is formed in the projection from the inner surface of the proximal metaepiphysis of the tibia 10 to the intercondylar elevation into the cavity of the knee joint. The position of the inner hole of the tunnel 9 is controlled by optics. Awl 8 is pushed up to the femur to the site of attachment of the anterior cruciate ligament. Subsequently, with an awl 8, a channel is formed in the lateral condyle of the femur 11 (Fig. 5). Above the sewn end 8, the skin is cut. A thick silk thread 12 is fixed to the awl 8 through the hole. The awl 8 is removed from the bones, the silk thread 12 is tied to the end of the graft. Using thread 12, the graft is pulled through the formed tunnels 9, pulled, the degree of tension is controlled by optics (Fig.6). The end of the graft 13 is fixed to the femur with a screw 14 (Fig. 7). A brace is applied and from the third day they begin to move in the knee joint without loading the limb.

The fundamental difference between the proposed method and the known one consists in creating the anterior cruciate ligament of the knee joint from the tendons of the semi-tendon and tender muscles on the feeding leg without cutting off the tendons from the fixation site by a closed method under the control of video arthroscopic technique. Semi-tendon and tender muscle abdomen sutured to m. sartorius.

The advantage of the proposed method over the prototype is as follows: from the tendons of the semi-tendon and tender muscles create a more durable transplant with natural fixation to the tibia, maintaining blood supply to the newly created ligament due to the tibial component. Suturing of cut muscles to m. sartorius helps to preserve their function, prevents atrophy of the above muscles, without violating the biomechanics of the limb.

The proposed method with a positive result was performed in a patient with a chronic rupture of the anterior cruciate ligament.

Patient A., 31 years old, was admitted to the clinic of traumatology and orthopedics of Samara State Medical University on 10.11.2006. Medical history No. 7256/335. From the anamnesis it is known that he was injured 6 months ago while playing soccer. Treated conservatively without effect. Diagnosis: chronic rupture of the anterior cruciate ligament of the right knee joint. January 16, 2007, an operation was performed according to the method developed by us. An examination of April 27, 2007 revealed: the range of motion in the knee joint is complete, the joint is stable, the symptom of the anterior drawer is negative.

The technical result. The use of an autograft on the feeding leg, its exact location in the joint and the degree of tension under the control of endoscopic optics create better conditions for the operation without opening the joint, which reduces trauma, reduces immobilization time, shortens the hospital bed, and facilitates postoperative rehabilitation.

The method is possible and appropriate to use in orthopedic and traumatic medical institutions in case of damage to the anterior cruciate ligament of the knee joint, to eliminate the instability of the latter.

Information sources

1. Arthroscopy, diagnosis and therapy. Harald Hempfling. Germany, 2000, 92 pp.

2. Instability of the knee joint. G.P. Kotelnikov, A.P. Chernov, S.N. Izmalkov. M., 2001, 230 pp.

Claims (1)

A method of surgical treatment of a chronic rupture of the anterior cruciate ligament of the knee joint by creating an autograft from the tendons of the semi-tendon and tender muscles, forming channels in the tibia and femur, conducting tendons through the channels under the control of arthroscopic technique, characterized in that the skin incision is made along the anteromedial surface of the upper third of the leg about 2-3 cm, at the level of anatomical attachment of the tendons of the semi-tendon and tender muscles, tendons secrete, do not cut off attachments on the tibia, then cut off at the transition to the muscle abdomen of these muscles, the latter are sutured to the tailor muscle, the tendons are sutured together, inserted into the bone canals and screwed to the femur.

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