交叉韧带重建术的实践与思考.ppt

学而不思则罔，思而不学则殆-交叉韧带重建术的实践与思考 泰山医学院附属医院运动医学科（骨3） Autologous graft tissue: Patellar tendon Semitendinosus tendon Gracilis tendon Quadriceps tendon Iliotibial band Achilles tendon Patella tendon graft Quadrupled hamstring autograft Bioabsorbable interference screws The bioabsorbable quality of the screws alleviates some problems associated with metal implants including graft laceration, postoperative imaging, revision surgery, and cold intolerance. Fixation equal or better to metallic interference screws. Fashioned from: poly-L-lactide (PLLA) tricalcium phosphate (TCP) Hydroxy-Apatite (HA) D.L-lactide Trimethyl Carbonate (TMC) Or combination Bioabsorbable interference screws 12 months 24 months 38 months Endobutton Four strand hamstring graft/endobutton pull through Cross-pin fixation rather than endobutton. Both types are fixed in the tibial tunnel with screw-sleeve fixation. 学而不思则罔，思而不学则殆-交叉韧带重建术的实践与思考 泰山医学院附属医院运动医学科（骨3） ACL reconstruction poor outcomes ACL graft failure Graft complications without failure Factors in ACL graft failure: Recurrent trauma Technical error Diagnostic error Failure of graft incorporation Intact graft with functional instability Recurrent trauma Premature return to high level of activity weakness of supporting muscles of the knee Minor trauma in conjuntion with technical error Technical Error Error in surgical technique is the most common cause of ACL graft failure. Nonanatomic graft placement-graft impingement on the intercondylar roof improper graft tensioning and inadequate graft fixation Anterior placement of the femoral tunnel is the most common surgical error Normal placement of ACL graft Tibial Tunnel Placement Evaluate on lateral view, knee in full extension. Anterior margin of the tibial tunnel should be behind a line drawn along the roof of the femoral notch (Blumensatt’s line). Center of the graft tunnel should be one-quarter to one-half the distance from the anterior to the posterior tibial