RESUMEN
The development of the arthroscopic surgery technique presented a great method in the reconstruction of anterior cruciate ligament. There were many debates about the timing of reconstruction in the acute anterior cruciate ligament injury. However, it was regarded true that primary reconstruction in the acute phase have higher complication rate of arthrofibrosis than in the chronic phase. Many authors recommended delay of reconstruction at least 3 weeks in acute tear of anterior cruciate ligament. In contrast, some surgeons have tried to suture the ruptured anterior cruciate ligament accompanied by 'over-the-top' augmentation with the hamstring tendon or the artificial ligament arthroscopically. Since Jan. 1992, the authors have implanted the synthetic polyester ligament(ABC ligament; Surgicraft, U.K.) into the substance of ruptured ligament proper and fixed at the 'over-the-top' position without any procedure for repair of the ruptured anterior cruciate ligament. Our indication for this surgery is only acute rupture of anterior cruciate ligament with good stump condition. We report the clinical results of 22 cases at 20.3 months follow-up(mean) preliminarily. l. On measurement of pre-operative and post-operative differences between the normal and the affected side by Telos stress X-ray study and KT-2000 arthrometer. Differences were markedly improved from 5.6mm(mean: pre-op) to 1.9mm(mean: post-op) on Telos stress X-ray study(on 15 Kp stress) and both knee showed minimal differences on KT-2000 study(2.2mm on 9Kp, 2.5mm on maximum stress) at the time of follow-up. 2. The average Lysholm score was 82. By Clancy criteria, the 20 cases(91%) showed good and excellent results. 3. Second look arthroscopy was available in three cases. In two cases, there were marked fibrous proliferation around the ligament. The stability felt good on probing. We could observe healing-like appearance of ruptured ACL with minimal fibrous tissue proliferation in one another case.
Asunto(s)
Ligamento Cruzado Anterior , Artroscopía , Estudios de Seguimiento , Rodilla , Ligamentos , Métodos , Poliésteres , Rotura , Cirujanos , Suturas , Lágrimas , TendonesRESUMEN
In the treatment of proximal tibial condyle fracture, it should be considered that it can often accompany injuries of the collateral ligament, both cruciate ligament, and the menisci of the knee. Moreover it is necessary to restore anatomical congruity of the articular surface accurately. We performed reduction of the depressed articular fragment under monitoring of arthroscopy and fixed with cannulated cancellous screws and accompanied by bone graft under the control of image intensifier in 2 cases of Type I(Pure cleavage) and 3 cases of type II(cleavage with depression) fractures. The results were very satisfactory. Arthroscopy assisted reduction and fixation are very useful method in the treatment of proximal tibial condyle fracture because of (1) the minimized operative morbidity, (2) the ability to evaluate and manage associated intraarticular pathology simultaneously, (3) the rapid rehabilitation, (4) the achievement of good reduction comparable to open reduction.