后交叉韧带重建随访ivan gerov md vladimir运动医学.pptx

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后交叉韧带重建随访ivan gerov md vladimir运动医学.pptx

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esinPosteriorCruciateLigamentReconstruction–5yearsfollowup

IvanGerov,MD

VladimirRoussimov,MD,PhD

MilitaryMedicalAcademy,Sofia,Bulgaria

PCLAnatomyAveragelength:32-38mmCrossSectionalArea:31.2mm21.5xthatofACLInsertionalcrosssectionalarea:3xlargerthanmidsubstanceMakesanatomicalreconstructiondifficult

Anatomy

FunctionPCLtravelsfromposteriorfoveaoftibia(1.5cminferiortojointline)tolateralborderofanteromedialfemoralcondyle.IntrarticularstructureRestrictposteriortibialtranslation(esp.at90o)2orestrainttovarus/valgus,externalrotationFunctionallytwobundlesPosteromedial-Tightensinextension,loosensinflexionAnterolateral(thisisonereconstructedinsinglebundlerecons)-Tightensinflexion,loosensinextension

MechanismFallonFlexedKneeDashboardInjuryLadderInjurySportsMotorVehicleIndustrial

PCLinjuries-classificationGradeI:0-5mm TibialplateauanteriortofemoralcondyleGradeII:5-10mm TibialplateauflushwithcondyleGradeIII:5-15mm Tibialplateauposteriortocondyle Oftencombinedinjuries

SymptomsMildkneeswelling,withorwithoutthekneegivingoutwhenwalkingorstanding,andwithorwithoutlimitationofmotion.Mildpainatthebackofthekneethatfeelsworsewhenkneeling.Paininthefrontofthekneewhenrunningortryingtoslowdown.Thissymptommaybeginonetotwoweeksaftertheinjuryorevenlater.

NonsurgicalTreatmentRICE.Whenfirstinjured.Immobilization.Straightleg,NWBfor4-5weksandPhysicaltherapy.Astheswellinggoesdown,acarefulrehabilitationprogramisstarted.Strengtheningthemuscles(quadriceps)

SurgicalTreatment

Surgicalinterventionismendedfor:thePCL/PLC-deficientkneewith10mmincreasedposteriortranslationand≥15°increasedexternalrotationSymptomaticGradeIIIlaxityDisplacedbonyavulsionfracturesThereareNOrandomizedtrialscomparingdifferentmethodsofsurgicaltreatment Transtibialvstibialinlay Single