Method for treating injured anterior cruciform ligament of knee joint

FIELD: medicine.

SUBSTANCE: method involves cutting out a flap for wrapping implant from synovial fat tissue available on anterior surface of the posterior cruciform ligament and intercondylar fossa roof capturing superficial layer of the posterior cruciform ligament.

EFFECT: enhanced effectiveness of treatment; improved ligament transplant remodeling conditions.

1 dwg

 

The present invention relates to medicine, namely to traumatology and orthopedics, in particular to methods for treating chronic injuries of the hand-ligaments of the knee joint, and can be used for the treatment of ruptures of the anterior cruciate ligament during in its absence or short stumps ligaments.

There is a method of treatment of chronic ruptures of the anterior cruciate ligament during by wrapping the graft synovial flap from the medial pterygoid folds on the supply leg (1).

The closest is the way static stabilization of the knee joint by plastics anterior cruciate ligament by ligament autograft patellar bone fragments with the formation of bone channels in the medial condyles of the femur and the tibia, the conduct of the graft through the channels and wrapping his intra-articular part of the proprietary flap synovial tissue (2).

However, the known methods of treatment have a number of significant drawbacks.

Thus, the use of synovial flap cut from the medial pterygoid folds (plica alaris medialis) for wrapping the graft anterior cruciate ligament violates the anatomy of the pterygoid folds, which impairs their functional properties as biological buffers

breaks Kong is wentest joint,

- contributes to the development of instability.

In addition to the above-mentioned disadvantages of the method static stabilization of the knee joint has the following:

- synovial flap pterygoid folds running from the front of body fat, having a good blood supply, however, has marked fibroblastic activity in the remodeling of the graft, as there is a close anatomical relationship with the cruciate ligaments.

Based on the existing level of technology in the treatment of injuries of the ligaments of the knee joint and eliminate the disadvantages of the known technology, the task was: to improve the remodeling of the graft anterior cruciate ligament due to the optimal conditions of its interaction with the internal environment of the joint, and reduce the invasiveness of the intervention.

The problem is solved as follows.

Treatment of injuries of the anterior cruciate ligament of the knee joint is carried out by replacement ligament implant and its wrapping flap on the supply leg.

New treatment technologies is the fact that flap for wrapping the implant is cut out from the synovial fat tissue located at the anterior surface of the posterior cruciate ligament and roof mimimally fossa with capture on ernestinovo layer of the posterior cruciate ligament.

Explain any significant distinguishing features of the proposed method of treatment.

The flap cut for wrapping the implant of synovial fat tissue located at the anterior surface of the posterior cruciate ligament and roof mimimally fossa with capture the superficial layer of the posterior cruciate ligament excludes trauma of the pterygoid folds and arising in connection with these violations.

The wrapping of the implant anterior cruciate ligament inner side of a cut flap ensures the contact of the implant with ligamentary layer of the flap.

Cut synovial fat ligamentary flap covering the posterior cruciate ligament is more fibroblastic potency and stimulates the growth of collagen structure on the basis of implantable material. Well krovosnabjaemah flap on the supply leg provides sealing of the implant from aggressive synovial environment with a high level of proteolytic enzymes.

Conducted patent research subclass a 61 In 17/56 and analysis of scientific and medical literature that reflects the existing level of technology in the field of methods of treatment of chronic ruptures of the anterior cruciate ligament of the knee joint during revealed no treatment methods are identical in at nakam proposed. Thus, the proposed method is new.

The relationship and interaction of the essential elements of the proposed method of treatment ensures the achievement of a new medical result in the solution of the problem, namely improving the effectiveness of treatment by increasing fibroblastic reaction in and around the implant anterior cruciate ligament, promoting more active growth of collagen tissue in the course of the implant, its protection during the period of adaptation from aggressive intra-articular environment, reducing trauma surgery and related disorders congruence, stability and biological buffer functions that cannot be solved by simple technological solutions and not obvious from the existing level of technology in the treatment of injuries of the knee joint. Thus, the proposed method of treatment involves an inventive step.

The proposed method of treatment can be widely applied in chronic ruptures of the anterior cruciate ligament of the knee joint throughout with resorption of her stump, as it does not require exceptional and extraordinary tools for its implementation.

The essence of the method consists in the following.

When detected during diagnostic arthroscopy or arthrotomy) short stump PE Edna cruciate ligament (ACL) or a total absence of it is the replacement of the PCB one of the implants (auto, ALLO, synthetic). To do this in the medial condyles of the femur and the tibia to form the channels (diameter 6-8 mm) with napravila, spokes and kannelirovannyh drills, which ensures the accuracy of the location of the outlet openings in the places of the former attachment of ligaments. Through the bone channels hold the implant. From synovial fat tissue located at the anterior surface of the posterior cruciate ligament (PCL) and the roof mimimally holes cut out synovial fat flap with a surface layer of PGS on the supply leg, size sufficient for wrapping the implant. Wrap the implant PCB internal sing flap (see drawing). The implant ligament pull, fix, check the stability of the joint. Operating accesses suture.

The essence of the proposed method is illustrated by a clinical example.

Patient B., 28 years old, football player, received 20.11.2000, Diagnosis:

Chronic injury of the anterior cruciate ligament, medial meniscus, articular cartilage condyles. Anteromedial instability of the right knee joint of the 3rd degree. Injury received in may 2000 while playing football. The patient was conducted conservative treatment in terms of emergency room (plaster immobilization, physiotherapy). From the proposed surgical treatment of a patient refused.

22.11.2000, the operation - dia is diagnostic arthroscopy of the right knee joint of the standard approaches. Found: 1. Complete rupture of the PCB for short spongy stumps. 2. Longitudinal-transverse rupture of posterior horn of medial meniscus. 3. Razvlechenija cartilage on the articular surface of the medial condyle of the femur, the tibia.

Produced: Arthroscopic resection of the medial meniscus. Cheilectomy spongy areas of the articular cartilage. In the medial condyles of the femur and the tibia formed channels with a diameter of 6 mm using napravila, spokes and kanalirovannykh drills. Using wire loops through the bone channels held bioinert polyester implant (80 fibers). From synovial fat tissue located at the anterior surface of the posterior cruciate ligament (PCL) and the roof mimimally holes cut synovial fat flap with a surface layer of PGS on the supply leg, and wrap the implant to the PCB inner layer of the flap. After the tension of the implant made its fixation at the exit of the bone channels two titanium kanalirovanie screws with Cavalcanti edges (length 25 mm, diameter 7 mm). Joint stability is achieved. Superimposed seams on operating accesses. Immobilization of the joint is articulated orthosis 0° extension and 0° flexion.

In the postoperative period, since 3-4 days, allowed movement in the joint (brace 0-30°) and walk n the crutches with the support of 15% of body weight. Gradually, the range of motion and support the load on the limb increased. After 4 weeks the hinged brace is removed, bending to 100°. Allowed to walk with a cane with a full load, stationary bike, recumbent and sitting "bike". After 6 weeks the patient walks without a cane, bending the joint to 120°. 8 weeks achieved full range of motion restored the tone and strength of muscles. Recommended increased training loads, exercising with weights, swimming, running over rough terrain with changes of direction. The patient returned to the former professional labour (football first League team). At follow-up visits after 6 months, 1 year: walks without limping, the support function of the limb is restored, full range of motion, stable joint, synovitis no. Control radiographs progression of degenerative changes are not marked.

Thus, the Method of treatment of injuries of the anterior cruciate ligament of the knee joint compared with other known technologies allows to create optimal conditions for amplification of fibroblastic reaction and stimulate the growth of collagen tissue in the course of the implant to secure the implant in the period of adaptation in the internal environment of the joint and thus increase its resistance to hyperextension during the rehabilitation period.

History is Nicky information taken into account

1. Minasov BS, Nikitin V.V. Protection and improvement of blood flow plastically restored cruciate ligament of the knee joint synovial flap on the feeding pedicle // Invention and rationalization in medicine. - M., 1989. - P.84-86.

2. RF patent 2113182, And 61 In 17/56. Method static stabilization of the knee joint / Lisitsyn BTW, Mironov S. p. Publ. 20.06.1998.

The method of treatment of injuries of the anterior cruciate ligament of the knee joint by the replacement ligament graft and its wrapping flap on the supply leg, characterized in that the flap for wrapping the implant is cut out from the synovial fat tissue located at the anterior surface of the posterior cruciate ligament and roof mimimally fossa with capture the superficial layer of the posterior cruciate ligament.



 

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