摘要:

As an anatomic structure the iliotibial band (iliotibialis tractus) has been used for more intra- and extraarticular procedures than any other autologous tissue. Physiologically, however, the surgical technique has often violated its anatomy by devascularizing this substantial extension of the tensor fascia latae and gluteus maximus muscles. Biomechanically, the iliotibial band has been shown to be the strongest substitute for the deficient anterior cruciate ligament (ACL) when tested as a free graft. The controversy about its strength arises when unequivalent tests are made with free grafts secured by proximal and distal bone blocks, thus invalidating the comparison.This article describes the subtleties of the surgical technique with the intraarticular transfer of the iliotibial muscle tendon unit that has evolved over ten years. Improvements on an anatomic and physiologic basis require strict attention to detail, which we have demonstrated through our intraoperative photographs.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Only recently has the majority of orthopaedic surgeons recognized that anterior cruciate ligament (ACL) insufficiency is one of the most common causes of knee instability and the most common cause due to knee ligament insufficiency. Numerous procedures have been proposed and utilized to compensate for ACL insufficiency, although only a few have survived the test of time.Three years ago, an arthroscopic-assisted patellar-tendon reconstruction technique was developed. This technique essentially eliminates the necessary but substantial surgical trauma to the extensor mechanism and capsular structures of the knee joint that required arthrotomy in delineating and developing the femoral and tibial tunnels. The arthroscopic technique significantly diminishes the intra- and extraarticular adhesions that produce prolonged rehabilitation time in gaining flexion and extension. The results of arthroscopic ACL reconstruction with patellar tendon reveal that the static results are as good as those produced by arthrotomy, with a much lower morbidity rate.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The rationale, advantages, and technique for using the lateral one third of the patellar tendon to reconstruct the anterior cruciate ligament (ACL) are presented. In this series of more than 450 consecutive cases, complications have been rare and results have consistently been very good.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A modified Marshall-Macintosh technique for anterior cruciate ligament (ACL) substitution is described. The graft is fashioned from the mid 50% to 60% of the patellar tendon extending to include prepatellar retinaculum and quadriceps tendon. A free tendon graft from the quadriceps tendon is used to reinforce the patellar tendon and retinaculum so that the graft is larger than the normal ACL. The graft is placed intraarticularly through isometric drill holes in the tibia and femur, then passed isometrically beneath the lateral collateral ligament, anchoring to Gerdy's tubercle for extraarticular reinforcement. An accelerated and aggressive knee rehabilitation program that has been employed with this surgical technique is described. Short-term results in 64 cases are encouraging.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The Gore-Tex ligament is a permanent prosthesis of polytetrafluoroethylene (PTFE) and has an ultimate tensile strength of 5,300 Newtons. The technique was originally designed for salvaging knees that had already failed anterior cruciate ligament (ACL) reconstructions. The technique allows for immediate full weight bearing and full range of motion without a cast or bracing.Over 1,000 Gore-Tex ACL reconstructions have been performed in the United States. The Southern California Orthopedic and Sports Medical Group has performed 103 Gore-Tex ACL reconstructions arthroscopically without extraarticular backup procedures.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A technique for a mini-reconstruction for both acute and chronic anterior cruciate ligament-deficient knees is presented, along with indications, contraindications, and a postoperative care plan. The mini reconstruction is designed as a tenodesis and augmentation of the iliotibial band to control anterolateral rotatory instability. A study of 60 patients treated with this technique has shown 91% good or excellent results after a two-year follow-up

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Isometric tenodesis of the iliotibial band is effective in alleviating functional instability due to anterior cruciate ligament (ACL) insufficiency in properly selected patients. A modification of Andrew's “minireconstruction” using a four-pronged table fixation staple is described. The procedure is simple, quick, and provides tissue fixation without necrosis or the need for a medial incision. There have been no hardware failures or staple migrations. The high percentage of good-to-excellent results at follow-up warrant continued use of this lateral extraarticular stablization procedure for ACL insufficiency.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

An arthroscopic technique utilizing a single tunnel has been developed for placing an anterior cruciate ligament (ACL) graft (a loop of semitendinosis tendon) along the anatomic axis of the normal ACL. Postoperative radiographs and direct arthroscopic visualization with intraoperative isometry testing of the graft have confirmed the anatomic position of the single tibiofemoral tunnel. Arthroscopic ACL reconstruction using the single tunnel technique has been performed on 38 patients and 40 knees. The longest follow-up period is 42 months. Postoperatively the pivot-shift test has been universally negative and no patient, subjectively or objectively, has reported giving way of the knee. Few complications have been reported using this technique. The procedure can be performed on an outpatient basis.With the use of a single tunnel, graft insertion is facilitated and, as there are less bends in the graft, it appears to be better biomechanically than traditional two-tunnel techniques. The early results of this technique are most encouraging; the technique could become a standard procedure for the experienced arthroscopist and knee surgeon.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A combined intraarticular and extraarticular operative procedure that can be used to treat the knee with a torn anterior cruciate ligament and functionally disabling recurrent anterior tibial subluxation is described. The procedure combines a distally based semitendinosus-tendon graft and a distally based iliotibial-tract graft. The semitendinosus tendon is passed up through an oblique drill hole in the anteromedial tibia, across the knee joint, over the top of the lateral femoral condyle (seated into a groove), and deep to the fibular collateral ligament. The iliotibial tract is passed in an identical course, but coming from the opposite direction: deep to the fibular collateral ligament, over the top of the lateral femoral condyle (into a groove), across the knee joint, and through the tibial drill hole. Both transfers are pulled tight and sutured one to the other. The posteromedial and lateral capsules are reefed.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A new fluoroarthroscopic technique for the installation of an allograft ligament to replace an anterior cruciate ligament (ACL) function is described. Failure of any device intended to function as an ACL, biologic or prosthetic, will occur if the principles of isometry and instant centers of motion in relation to sites of ligament origin and insertion are ignored. At least equal preoperative planning and precise measurements should be made regarding ACL reconstruction as is presently required for the total-kneereplacement technique. The former is certainly less forgiving than the latter.The cruciate ligament organ obeys the principles of a four-bar, chain-link system. Abnormal compression and distraction forces will occur at the articular surface of the knee if points of contact (between the femur and the tibia) are changed due to an abnormally reconstructed ACL.Human cadaver knee dissections were performed. ACLs were opaquely tagged and their radiologic shadows studied fluoroscopically. Instant centers of motion were tested to determine acceptable surgical sites of origin and insertion of the intended ACL allograft.The site of femoral attachment was found fluoroscopically to exist 3 mm anterior to the junction of the posterior femoral cortex and the intercondylar cortical seam. A new attachment device has been developed to allow attachments of the allograft to the femur without the need for a posterolateral incision.The success of the reconstruction is a function of graft physiology, correct interpretation of knee biomechanics, and ultimately a long-term followup. The study is therefore a preliminary report emphasizing principles and surgical detail.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID