一种新型的微创非解剖单束内侧副韧带重建技术与短等距构造跟腱异体移植：多韧带膝关节损伤患者的临床和放射学结果的外科描述。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-12-15 DOI:10.1002/jeo2.70076

Mohammadreza Minator Sajjadi, Alireza Mirahmadi, Vahid Alizad, Mohammedhasan Dabis, Ali Saeidi, Mohammad Movahedinia

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引用次数: 0

摘要

目的：膝关节多韧带损伤（MLKIs）涉及膝关节的各种韧带。目前的内侧副韧带（MCL）双束解剖重建增加了技术的复杂性，往往导致建立许多骨隧道和使用额外硬件的不同固定点。为了克服这些局限性，我们提出了一种新颖的微创非解剖 MCL 重建方法，即在 MLKI 环境下使用跟腱异体移植物在干骺端建立一个胫骨隧道：在一项回顾性研究中，我们招募了24名MLKI患者，他们在2020年和2021年期间接受了新的单股短等长结构（SIC）非解剖MCL重建术。我们在股骨远端内上髁上的一个隧道和胫骨干骺端上的一个隧道中使用过盈螺钉固定了跟腱异体移植物，过盈螺钉位于 MCL 浅层解剖插入部和后斜韧带之间的关节线下 2 厘米处。患者在术后1-2年的最后一次随访中接受了临床和放射学评估，包括外翻应力X光片、活动范围（ROM）、Lysholm和国际膝关节文献委员会（IKDC）评分：术后IKDC平均评分为77.8分（范围为50.1-86.6分）。Lysholm 评分的平均值为 84.1 ± 11.9（范围为 96-59）。经测量，膝关节内侧增宽差（即外翻应力X光片下的平均侧对侧差值）平均为1.2毫米。只有两名患者（8%）膝关节屈曲活动度受限达20°，其中一名患者手术失败。结果显示，根据受累韧带的数量，患者的治疗效果存在明显的统计学差异：结论：这种采用单一胫骨骺隧道的新型 SIC 类技术在患者报告结果、外翻应力X光片、膝关节活动度、膝关节僵硬率和移植物失败率方面均令人满意。虽然MLKI患者受伤韧带的数量对结果有很大影响，但所有患者的结果都是可以接受的：证据等级：IV 级。

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A novel minimally invasive nonanatomical single-bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

Purpose

Multiligament knee injuries (MLKIs) involve various ligaments in the knee. Current double-bundle anatomical reconstructions of the medial collateral ligament (MCL) increase the level of technical complexity, often resulting in the establishment of numerous bone tunnels and different fixation points with additional hardware. To overcome these limitations, we proposed a novel minimally invasive nonanatomical MCL reconstruction with one tibial tunnel in the metaphysis using Achilles allograft in the MLKI setting.

Methods

In a retrospective study, we enroled 24 patients with MLKIs who underwent a new single-strand short isometric construct (SIC) nonanatomical MCL reconstruction during 2020 and 2021. We fixed an Achilles allograft in one tunnel in the distal femur on the medial epicondyle and one tunnel in the metaphyseal part of the tibia using interference screws at 2 cm below the joint line between the anatomical insertion of the superficial MCL and the posterior oblique ligament. The patients underwent clinical and radiological assessment at the last follow-up, 1–2 years after the operation, including valgus stress radiographs, range of motion (ROM), Lysholm and International Knee Documentation Committee (IKDC) scores.

Results

The mean postoperative IKDC score was 77.8 (range, 50.1–86.6). The mean Lysholm score was 84.1 ± 11.9 (range, 96–59). The medial knee widening difference (i.e., mean side-to-side difference under valgus stress x-ray) was measured to be 1.2 mm on average. Only two patients (8%) had ROM limitation of 20° in knee flexion, one of which had surgery failure. Results showed a significant statistical difference between the patients' outcomes according to the number of involved ligaments.

Conclusions

This novel SIC-like technique with a single tibial metaphyseal tunnel demonstrated satisfactory patient-reported outcome measures, valgus stress radiographs, ROM and a low rate of knee stiffness and graft failure. While the number of injured ligaments in MLKI patients significantly influenced the outcomes, the results remained acceptable across all patients.