دانلود رایگان مقاله بازسازی راه پوست انترولترال رباط زانو با نوار پلی استر

Abstract

Recent advances in surgeons' understanding of the anatomic, biomechanical, and radiologic features of the anterolateral ligament (ALL) of the knee have led to an increased interest in reconstruction of this structure as part of the management of knee instability. Even without any technical flaws and proper positioning of the bone tunnels, there is a small subset of patients, approximately 7% of all patients, who experience some residual anterolateral rotational instability after anterior cruciate ligament reconstruction. For this reason, some researchers have turned again toward the anterolateral aspect of the knee and specifically the ALL. In this technical note, the surgical steps for percutaneous reconstruction of ALL of the knee using a polyester tape are described.

Discussion

Extra-articular reconstruction techniques for management of ACL injuries were pioneered by Strickler (1937), Lemaire (1960), and MacIntosh (1970s), using a lateral extra-articular tenodesis to control anterolateral tibial subluxation.20 Although these techniques were shown to control external rotational laxity, they were soon found to stretch out and not control the knee to the desired manner. This then led the way to combined intra- and extra-articular reconstruction. Interestingly, although the combined procedure by and large went out of fashion in the late 1990s, extra-articular tenodesis is making somewhat of a resurgence, with a number of authors using the procedure to aid control of rotational laxity, particularly in revision scenarios.21 Current techniques of ACL reconstruction may not achieve normal control of knee rotation.14,22 The presence of an extra-articular structure responsible for limiting anterolateral rotatory laxity of the knee may explain why isolated intra-articular reconstructions, even when performed correctly, are not always suffi- cient to restore the rotatory movements of the knee.1