RU2320383C1 - Method for treating partial lesion in anterior cruciate ligament of knee joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: one should fulfill arthroscopy in aqueous medium at pressure ranged 60-80 Pa, the knee join should be bent at the angle of 140-160°. One should put marks at the border of the lesion. One should place a light-fiber guide at distance of about 2-4 mm being above the lesion site followed by irradiating with laser at wave length being 0.97 mcm, power 10.0-11.9 W, rate ranged 2-4 mm/sec. Then one should remove and coagulation free fibers. Then comes mosaic impact onto the parts of partially stretched fibers till visible compression at wave length being 0.97 mcm, power ranged 10.0-11.9. The innovation enables to restore anatomical integrity of partially destructed anterior cruciate ligament and stability of a knee joint. The innovation is being a launcher for regenerating the affected fibers according to the type of wound healing due to primary tightening.

EFFECT: higher efficiency of therapy.

1 cl, 2 ex

Description

The invention relates to medicine, in particular to the section of traumatology and orthopedics.

The knee joint is one of the large joints of the human musculoskeletal system. Stable joint work is ensured by all elements of the capsule-ligamentous apparatus. One of the main stabilizing elements of the knee joint is the anterior cruciate ligament (PCL). Damage to the anterior cruciate ligament leads to instability of the knee joint. Instability of the knee joint can lead to the development of gonarthrosis.

One of the main causes of damage to the cruciate ligaments of the knee joint is injury. Damage to the anterior cruciate ligament may be partial or complete. The restoration of complete damage to the anterior cruciate ligament with its rupture is possible by the method of classical prosthetics with a synthetic prosthesis or an autograft from the patient’s ligaments. Partial ligament damage often remains without surgical treatment. Conservative methods of treating partial damage to the anterior cruciate ligament, such as limiting movement or gypsum mobilization, physiotherapeutic treatment, do not lead to its full recovery. With repeated loads, further unraveling of the undamaged part of the ligament occurs with the gradual involvement of other components of the joint in the process. Based on this, with partial damage to the ligament, it is necessary to achieve its restoration.

A known method of intra-articular laser irradiation, which is used in patients with a primary lesion of the capsule-ligamentous apparatus of the knee joint of an inflammatory-dystrophic nature (Berglezov M.A., Vyalko V.V., Ugnivenko V.I. "Invasive methods of laser therapy in traumatology and orthopedics. Methodical recommendations ", - M., - 1995. - 21 S.). The method consists in puncture of the joint with a thin needle through which the joint cavity is filled with oxygen. Then the joint is punctured with a needle with a wide clearance through which the light guide is drawn. Under the control of a spot glowing through the skin, the light guide is brought to the affected area of the joint (upper inversion, region of the pterygoid ligament). For irradiation using the light of a helium-neon laser with a radiation power at the working end of the fiber 10-15 mW / cm ² . The procedure is repeated after 3-4 days. The total number of sessions 4-6 lasting 15-20 minutes. As a result of treatment, the symptoms of synovitis, flexion contracture are eliminated, the pain syndrome decreases, the anatomical, physiological and biomechanical parameters of the joints are normalized.

The disadvantages of this method include the inability to accurately localize the location of the laser beam on the affected joint structures, resulting soft tissue necrosis within 6 weeks after surgery, the procedure requires repeated treatment.

There is also a method of treating partial damage to the anterior cruciate ligament (S. Ivannikov, O. Oganesyan, N. Gear "Laser arthroscopic surgery. Degenerative-dystrophic lesions of the knee joint." - M., - 2002. - 101 C.), with which with incomplete rupture of the ligament, partial damage is eliminated in cases where the stump of one of the bundles of the anterior cruciate ligament serves as a blocking joint element. The blocking element is cut off using a neodymium laser, and individual fibers are coagulated (Lamin-1, wavelength (λ) = 1.06 μm, power 70 W, diameter (∂) of the optical fiber 600 μm, max continuous operation time ≤30 min , red backlight, weight 100-140 kg).

The arthroscope is left inserted through the lower lateral approach, and a laser tip is usually inserted through the lower medial approach, usually with direct radiation output. If the stump of the ligament was more than 3 mm long and could serve as an obstacle and be injured during the movement of the knee joint, it is cut off with a laser beam. For this, the laser tip is installed at the base of the stump, the 30 W mode is turned on. By translational movements of the tip at a speed of 1 mm / s, the stump is crossed, and the fragment is removed from the joint with an arthroscopic clamp. To prevent further ligament spallation, short bundles of fibers are evaporated and coagulated, after which the disintegration disappears. The power mode is 25 watts, and the movement of the tip accelerate to 2-3 mm / s. A laser installation based on a high-power near-infrared solid-state laser based on yttrium aluminum garnet is used, using red illumination and a working wavelength of 1.06 μm.

The disadvantages of this method include the lack of impact on the ligament itself at the site of damage, the method does not completely restore the PCS and accordingly does not exclude the risk of developing instability of the knee joint, the use of red backlighting, which makes orientation inside the joint difficult.

The objective of the invention is a method of treating a partially damaged anterior cruciate ligament, leading to the complete restoration of its anatomical integrity and stability of the knee joint.

The problem is solved by the method consisting in the fact that arthroscopy is performed in an aqueous medium at a pressure of 60-80 Pa, the knee joint is bent at an angle of 140-160 °, marks are applied at the damage boundaries, a fiber-optic conductor is placed at a distance of 2-4 mm above the damage site and first, a laser with a wavelength of 0.97 μm, a power of 10.0-11.9 W, and a speed of 2-4 mm / s is irradiated, after which the free fibers are removed and coagulated, then a mosaic effect is carried out in areas of partially stretched fibers to visible wavelength compression 0.97 microns, power 10.0-11.9 watts. Removal and coagulation of free fibers is carried out with an impact speed of 3-4 mm / s.

To implement the method can be used a semiconductor diode laser LLC NTO "IRE-Polyus" (reg., No. 29/01050501 / 2512-01 (/ 2513-01) from 09/06/01, No. 29/01040499 / 1055-00 from 02.11.00) with a continuous mode of radiation generation and the following technical characteristics: wavelength 0.97 μm, power 11.9 W, optical fiber diameter 300 μm, maximum continuous operation time ≥30 min, green backlight, weight 7-9 kg

The method is as follows.

After spinal anesthesia, the lower limb is laid and fixed with a turnstile. For the effectiveness of laser exposure under the supervision of an arthroscope, the knee joint is bent to 140-160 °, before the twisting of the PCB, the arthroscope is left inserted through the lower lateral access. To exclude carbonization of the tissue, arthroscopy is performed on an aqueous medium using a pump at a pressure of 60-80 Pa. Before the laser exposure begins, the PCD is examined with a probe. A fiber holder is inserted through the lower medial access. The degree of insolvency of the ligament is assessed when reproducing the Lachman test (damage markers are marked with a laser marker, the lower leg is advanced, the distance between marker marks is taken into account). The fiber optic conductor is installed at a distance of 2-4 mm above the site of damage, include 10.0-11.9 watts. The translational movements perform irradiation of the damage site at a speed of 2-4 mm / s, visually monitoring the compression of the fibers, the convergence of the marker marks. When re-playing the Lachman test, the distance between marker marks is counted. Then perform a mosaic effect on the areas of partially stretched fibers to their maximum reduction. The laser operating mode was 10.0–11.9 W, and the tip movements were accelerated to 4 mm / s. To prevent further ligament spallation, short bundles of free fibers are coagulated with a beam to eliminate the “spallation" effect.

CLINICAL EXAMPLE

1) Patient V. 17 years old, during physical education at school, fell. There was swelling of the joint, pain during flexion. I went to the clinic for medical help. A course of physiotherapeutic treatment was prescribed. Over the next 4 months, often noted instability in the knee joint, pain during flexion and axial load, swelling. A repeated visit to the doctor on ultrasound, MRI revealed a partial damage to the PCS, the anterior horn of the medial meniscus, the posterior horn of the lateral meniscus. Hospitalized in a hospital for surgical treatment. In the study: clinically, ultrasound, MRI, stabilometric testing confirmed partial damage to the PCS, the initial manifestations of post-traumatic gonarthrosis. During arthroscopic surgery, partial damage to the anterior cruciate ligament with fiber breaks of 5 by 3 mm and a depth of 2 mm, 3 by 4 mm and a depth of 4 mm, the presence of free fibers in the form of breaking up was determined. After spinal anesthesia, a water pump is turned on at a pressure of 60 Pa, the knee joint is bent at an angle of 140 °, visually monitoring the onset of twisting of the PCB fibers. Label with a diode laser at the boundaries of the damage, the fiber optic conductor is installed at a distance of 4 mm above the damage site and is exposed to a laser at a wavelength of 0.97 μm, a power of 10.0 W at a speed of 2 mm / s until visible compression. Removal and coagulation of free fibers is carried out with an impact speed of 3-4 mm / s. Then a laser mosaic effect is carried out on the areas of partially stretched fibers until visible compression. In the postoperative period, the lower limb is immobilized in a splint. A 3-week rehabilitation course of treatment was carried out. At the end of the rehabilitation period, the patient noted the absence of swelling, pain during flexion, the phenomenon of instability in the knee joint and could begin to fully load the joint.

In terms of 1 month, 3, 6 months to 2 years, clinical, MRI, ultrasound, and stabilometric monitoring were performed. There were no signs of damage to the PKC, symptoms of instability of the knee joint in the patient.

Example No. 2. Patient V., 38 years old, while playing football, felt a crunch and pain in his right knee joint. He went to the doctor after 7 days, when the pain in the knee joint intensified, a feeling of discomfort appeared. He was hospitalized in a hospital for examination and surgical treatment. In the study: clinically, ultrasound, MRI, revealed partial damage to the PCS. During arthroscopic surgery, partial damage to the anterior cruciate ligament was determined with the fibers breaking to a width of 4 mm and a depth of 3 mm, with the presence of free fibers in the form of breaking up. After spinal anesthesia, a water pump is turned on at a pressure of 80 Pa, the knee joint is bent under an angle of 160 °, visually controlling the onset of twisting of the PKC fibers. Label with a diode laser at the boundaries of the damage, install a fiber optic conductor at a distance of 2 mm above the damage site and expose it to a laser at a wavelength of 0.97 μm, a power of 11.9 W at a speed of 4 mm / s until visible compression. Removal and coagulation of free fibers is carried out with an impact speed of 3-4 mm / s. Then a laser mosaic effect is carried out on the areas of partially stretched fibers until visible compression. In the postoperative period, the lower limb is immobilized in a splint. A 2-week rehabilitation course of treatment was carried out. At the end of the rehabilitation period, the patient noted the absence of pain, discomfort, and could begin to fully load the joint.

In terms of 1 month, 3, 6 months to 2 years, clinical, MRI, ultrasound, and stabilometric monitoring were performed. There were no signs of damage to the PKC, symptoms of instability of the knee joint in the patient.

The method according to the invention allows:

- restore the anatomical integrity of the partially damaged anterior cruciate ligament and the stability of the knee joint, is the trigger for the regeneration of damaged fibers by the type of wound healing by primary intention;

- act directly on the ligament in the place of its damage;

- conduct treatment taking into account the biomechanics of the anterior cruciate ligament;

- reduce the degree of trauma to surrounding tissues, due to the dispersion of laser radiation in the aquatic environment and the absence of a coagulation scab, due to the proposed level of laser power and the use of a water pump.

According to the presented method of treatment, 154 patients were treated. Of these, 141 patients had a good result, satisfactory - in 10 patients and 3 patients had an unsatisfactory result, due to non-compliance with the recommendations of the attending physician in the postoperative period.

Claims (2)

1. A method of arthroscopic laser treatment of partial damage to the anterior cruciate ligament of the knee joint, characterized in that arthroscopy is performed in an aqueous medium at a pressure of 60-80 Pa, the knee joint is bent at an angle of 140-160 °, marks are made at the boundaries of the damage, a fiber optic conductor is placed on a distance of 2-4 mm above the site of damage and first irradiated with a laser with a wavelength of 0.97 μm, power 10.0-11.9 W, speed 2-4 mm / s, after which the free fibers are removed and coagulated, then mosaic vozeydes Particularly stretched fibers to visible compression with a wavelength of 0.97 microns, power 10.0-11.9 watts. 2. The method according to claim 1, characterized in that the removal and coagulation of free fibers is carried out with an impact speed of 3-4 mm / s.