脊柱-南醫(yī)三院

1、ACL RECONSTRUCTION WITH ARTHROSCOPY AND C ARMProf. Irfan MehboobHead Dept of Orthopaedics LGH/AMCWhat is an ACLStabilizing knee ligamentPrevent abnormal anterior displacement and rotation of tibia on femurUltimate tensile load and stiffness is 2160N and 242NACL TearsRisk of injury 1 :3000Football an

2、d basketball in young patientsSkiingSubstantial anterior tibial shear forces stress acl from quads contractionTypically torn in noncontact deceleration results in Valgus twisting injurySignificance of ACL tearPersistant joint instability and painStructures at riskMeniscus injuries 40 to 50% leads to

3、 degenerative changes50% reparableArticular cartilage 80%Bone bruise leads to cartilage thinning in 65% at 6 yearsIndications of surgeryDegree of ACL injuryPresence of associated ligamentous, meniscal and chondral inuriesAge/activity level/occupationSports participationPatient compliance with post o

4、p rehabFirst attempt= BEST attemptRevision surgery es 50 to 70% good - excellentTreatment options (Surgical) ACL reconstruction (Conventional B-PT-B)Arthroscopic ACL reconstruction using quadruple Hamstring graftB-PT-B Graft ACL Recon using Arthroscope+ Image intensifier Knee joint ArthroscopyNot on

5、ly can arthroscopy be used for diagnosis of certain conditions in joints, it can also be a method of operative treatment.Repair/partial menisectomySystematic approachSuprapatellar pouch and patellofemoral jointMedial gutterMedial compartmentIntercondylar notchPosteromedial compartmentLateral compart

6、mentLateral gutter and posterolateral compartmentThe Knee: standard portalsAnterolateral, anteromedial, posteromedial and superolateralThe Knee: diagnostic examinationWhat can we see with the scope?Medial meniscusLateral meniscusAnterior and posterior cruciate ligamentsCondition of cartilageThe Knee

7、: diagnostic examinationWhat can we see with the scope?Medial meniscusLateral meniscusAnterior and posterior cruciate ligamentsCondition of cartilageThe medial meniscusThe medial meniscal tearThe lateral meniscusThe lateral meniscal tearLesions of the ACL: freshLesion of the ACL: not so freshConditi

8、on of the cartilage: patellofemoral arthrosisCondition of the cartilage: osteochondritis dissecansWhy Image Intensifier?Why use Image Intensifier“Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been show

9、n to improve the accuracy of tunnel placement”Ann R Coll Surg Engl 2010; 92: 330334When creating the femoral tunnel during endoscopic anterior cruciate ligament reconstruction, the potential exists for penetration of the posterior femoral cortex. In addition, during placement of the proximal fixatio

10、n screw, the screw can deviate from its intended path. We have used an image intensifier intraoperatively to obtain a lateral view of the knee to enable the assessment of tunnel placement and screw alignment. This technique assures the accurate placement of the tibial and femoral tunnels and helps a

11、void screw divergence from the graftThe Journal of Arthroscopic & Related Surgery Volume 9, Issue 5, October 1993“The use of an intra-operative image intensifier can help the surgeon to achieve accurate and reproducible tunnel placement in ACL reconstruction surgery. We mend this technique to all surgeons