采用双无结全缝线锚钉覆盖固定的外侧关节外肌腱固定术
简介
本文介绍LET联合ACLR的一种新固定技术：取髂胫束条带经外侧副韧带深方穿过后，于股骨外上髁近后侧以双无结全缝线锚钉行onlay表面固定，膝屈曲30°、胫骨中立位下完成。文献提示，高风险患者加做LET可改善旋转稳定性、降低移植物断裂率，且不偏离标准ACLR术后康复方案、不增加短期或中期并发症，临床应严格把握适应证。
英文摘要
BACKGROUND: Lateral extra-articular augmentation procedures, including lateral extra-articular tenodesis (LET), are advocated in high-risk patients undergoing anterior cruciate ligament reconstruction (ACLR) to provide improved rotational stability and reduce rates of graft rupture postoperatively. INDICATIONS: Indications for performing a LET concomitantly with ACLR continue to evolve, but are recommended for patients with certain demographics and in the presence of anatomic risk factors for graft rupture. TECHNIQUE DESCRIPTION: After the ACL femoral tunnel is reamed, a lateral approach to the knee is performed, and an 8 cm long by 1 cm wide strip of the posterior iliotibial band is harvested and passed retrograde, deep to the lateral collateral ligament. While "tunneloscopy" is performed to confirm the absence of tunnel interference, a double-knotless, all-suture anchor is placed just proximal and posterior to the lateral epicondyle. After the ACL graft is passed and fixated, the limb is positioned in 30° of knee flexion and neutral tibial rotation. The double-knotless mechanism is then employed to achieve surface fixation of the LET graft. RESULTS: The literature suggests that performing a LET with ACLR improves rotational stability and reduces the rate of graft rupture postoperatively in high-risk patients, without deviating from standard ACLR postoperative protocols or causing additional morbidity at short- or midterm follow-up. DISCUSSION/CONCLUSION: This article demonstrates a safe and reproducible method of performing a LET concomitantly with ACLR using a quadriceps autograft in appropriately indicated patients. Ongoing research continues to refine the indications and techniques for performing a LET with ACLR. PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.