1 / 21

Oct, 3 to 6 2012 Ankara Arthroscopi Postero-lateral Reconstruction

Oct, 3 to 6 2012 Ankara Arthroscopi Postero-lateral Reconstruction. M. Razi. MD; Rasoul Akram University Hospital Tehran. Anatomy postero-lateral structures PLS. Lateral collateral ligament LCL Arcuate complex

galeno
Download Presentation

Oct, 3 to 6 2012 Ankara Arthroscopi Postero-lateral Reconstruction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Oct, 3 to 6 2012 Ankara Arthroscopi Postero-lateral Reconstruction M. Razi. MD; Rasoul Akram University Hospital Tehran

  2. Anatomy postero-lateral structures PLS • Lateral collateral ligament LCL • Arcuate complex Augmented by dynamic effect of popliteus, long head of biceps, & lateral head of Gastrocnemius.

  3. BIOMECHANICS LaPrade et al. in a cadaveric study Am J Sports Med 2009 Popliteus tendon has major ligament like as primary stabilizer to external rotation and to lesser extent a primary stabilizing role to internal rotation, varus angulations, and anterior translation. 5th major ligament of the knee

  4. Repair Vs Reconstruction Stannard et al Am J sport Med 2005 in a prospective trial comparing repair versus reconstruction of PLC . The repair failure rate was 37% and reconst.. Failure rate was 9% Stannard et al Am J sport Med 2005 in a prospective trial comparing repair versus reconstruction of PLC . The repair failure rate was 37% and reconst.. Failure rate was 9%

  5. Early versus delayed surgery Acute definitive surgery occurs within 3 weeks general consensus • Bruce et al J Arth.. & Rela.. Surg 2009 in an evidence based article review: early operative treatment yields improved functional and clinical outcomes compared to non operative or delayed surgery. but repair of PLC yields to higher revision rate.

  6. Posterolateral structure PLS and ACL injuries • Well known but difficult management • Difficult diagnosis in subtle cases • Surgical treatment is recommended • Limb alignment is an important factor

  7. diagnosis chronic

  8. Posterolateral structure PLS and ACL injuries • Well known but difficult management • Difficult diagnosis in subtle cases • Surgical treatment is recommended • Limb alignment is an important factor

  9. Posterolateral structure PLS and ACL injuries treatment options in varus malalign.. HTO & ACL or FU ACL or ACL and PLS reconst.. Early RepairFU ACL ? Repair and augmentation FU ACL reconst.. ACL & PLS Reconstruction Larson LaPrade

  10. how to reduce post operative failures in combined ACL and PLS injuries: • ACL and LCL reconst.. In mild injuries modified Larson • ACL and LCL reconst.. And arthroscopic popliteus tendon reconstruction in more severe cases • Consider limb alignment and type of sport La Prade Larson

  11. Criteria to do surgery

  12. Modified Larson technique Larson

  13. Why to do arthroscopic surgery

  14. Arthroscopic PLS reconstruction

  15. Arthroscopic PLS reconstruction

  16. My recommended algorithm choice Grade I PLS injury or insufficiency due to joint laxity: modified Larson Grade II depending to involved structure: arthroscopic allograft popliteus reconstruction or modified Larson. Grade III: combined arthroscopic popliteus tendon reconstruction and Larson.

  17. August 2005 to April 2011 39 cases 8 female and 31 men • 27 cases ACL and PLS • 9 cases PCL and PLS • 3 cases ACL PCL PLS • FU 6m to 5 year 33 +/- 1 M

  18. Results • All patients close to normal • No limitation of motion or arthrofibrosis IKDC 2000 • Increase of the scores of pain and activity • Scores for varus external Rotation , reversed pivot shift and single leg hope

  19. advantage: restoration of varus and external rotation laxity , reservation of anatomical position of non injured part of structures and reduced potential surgical damage by arthroscopy compared to open dissection of PLS.

  20. Conclusion: This modified arthroscopic-assisted technique to reconstruct the primary static stabilizers of the posterolateral knee restored static stability with least surgical morbidity

  21. thank you Perspolis

More Related