Augmented repair with early mobilization of acute anterior cruciate ligament injuries

Abstract

Although a succesful method for repairing the ruptured anterior cruciate ligament (ACL) would seem desirable in order to preserve the naturel isometric position and the mechanical and proprioceptive function of the ACL, attempts to achieve surgical repair have generally yielded poor results. This paper describes a technique for repair of the ACL with protection of that repair by a synhetic augmentation device. This technique minimizes damage to proprioceptive elements, can be carried out with a mini arthrotomy and eliminates the adverse effects of postoperative immobilization. In addition, the immediate restabilization of the joint provided by the augmentation device converts grade III collateralligament injuries to a grade II condition and thus allows nonoperative treatment of concomitant collateralligament injuries. \nOf 61 patients operated 24 to 57 months (mean 38. 3 months) prior to data accumulation, 57 returned for follow up Subjectively, 93% of all patients reported a good or excellent functional result, however only 50.9% of the patients returned to their preinjury sports Ievel. Objectively, a radiographic Lachman test was performed on both the injured and the noninjured knee of all 57 patients. The preoperative mean difference between the kness was 8. 6 mm (range 4. 6 to 17. 2 mm) and of follow up was 2. 4 mm (range 0.9 to 11.8 mm). Radiographic abduction and adduction stress test demonstrated stable healing of the (unrepaired) collateralligament lesions (varus stress 0.1 mm and valgus stress 0.4 mm mean side-to-side difference), indication that suture of ruptured collateralligaments is not necessary when the knee is centrally stabilized with the augmentation device. These results indicate that succesful repair of the anterior cruciate ligament is frequently possible when enhanced by an augmentation device. We feel that a successful repair with preservation of the normal structures is distinctly preferable to reconstruction.

Özet

Doğal izometrik pozisyonu ve ÖÇB in mekanik ve proprioseptif fonksiyonu korumak için başarılı bir cerrahi girişimle ÖÇB yırtığını onarmak gerekirse de cerrahi onarım girişimleri genel olarak başarısız sonuçlar vermiştir. Bu bildiride onarım sonrasında koruma amacı güden sentetik güçlendirici aracın kullanıldığı bir teknik anlatılmaktadır. Bu teknik propriseptif elemanlara zaran minumuma indirger, çok ufak bir artrotomiyle yapılabilir ve postoperatif immobilizasyonun yan etkilerini ortadan kaldırır. Ayrıca stabilizasyon yeniden hemen sağlanmasıyla grade III yan bağ yaralanmaları grade II konumunu koruyan ve böylece eşlik eden yan bağ lezyonunun nonoperatif tedavisi mümkün olur. Aşağıda tekniğimizi uyguladığımız serimizi ve sonuçlarımızı göreceksiniz.