1、Anterior Cruciate Ligament Injury Han Guibinorthopaedics department Haikou municipal peoples hospitalMEDICAL TERMSanterior cruciate ligament（ACL）femoral condylar notchsynoviumeversioninversiongraftpatellartibial plateau前交叉韧带股骨髁间窝滑膜外翻内翻移植物髌骨的胫骨平台INCIDENCEIt has been estimated that 100,000 anterior cr
2、uciate ligaments are torn each yearin the United States. RISK FACTORSgender : female occupation: athlete the intercondylar notch width index : lower indexEPIDEMIOLOGYANATOMY Originates from the lateral femoral condyle within the condylar notch and inserts on the tibial plateau.31 to 35 mm in length
3、and 31.3 mm2 in cross section. A two-bundle ligament, consisting of a small anteromedial and a larger posterolateral bundle.Surrounded by synovium. side elevationfinite graphfrant elevation PATHOGENESISContact injuryEversionInversion Hyperextended Anterior and posterior remotionNoncontact injuryDece
4、leration in jumping, or cutting action SYMPTOMSAn audible pop or crack A feeling of initial instabilityExtreme painDysfunctionlimited range of motionSwelling & tendernessanterior drawer testpivot shift testfloating patella testLachman testSIGNSINVESTIGATIONSgolden standardsensitiveeffective ineffect
5、ivearthroscopeMRI、KT-1000ultrasonography、CTX-rayTREATMENTlolder people lwilling to make lifestyle changesl avoid the activities that cause recurrent instabilitylage llifestyleloccupationldegree of knee instability lassociated injurieslyounger peoplel regularly plays sport llikely to adhere to a comp
6、lex rehabilitation programDecisionfactorsNonoperative treatmentSurgical treatmentSurgicaltreatmentRepairRepair withaugmentation Reconstruction SURGICAL TREATMENT extraarticularprocedures combinedinstabilitiesintraarticular proceduresarthroscopic techniquesClick to ignore two slides about operation d
7、etailsRECONSTRUCTION TECHNIQUEARTHROSCOPY TECHNIQUE OF ACL RECONSTRUCTIONHarvesting the GraftPreparing the GraftDrilling the tibial tunnelDrilling the Femoral tunnelPulling the graft in placeFemoral FixationTibial FixationA CARTOON OF ACL RECONSTRUCTIONCOMPLICATIONS OF ACL SURGERY1appropriate timing
8、 of surgery; adequate preoperative conditioning and strengthening; graft and fixation choices 2 patellar fracture, inadequate graft length, mismatch between the bone plug and tunnel sizes, graft fracture, suture laceration, violation of the posterior femoral cortex, and incorrect femoral or tibial t
9、unnel placement3motion (primarily extension) deficits persistent anterior knee painpreoperativeintraoperative postoperative PROGNOSISnonoperativeAfter a mean follow-up of 7 years, 83% were satisfied with the results.repairResearchers concluded :a nonaugmented primary repair should not be done ; repair with a ligament augmentation had an unacceptably high failure rate .reconstructionMost current studies report a 90% to 95% success rate in restoring stability as defined by a KT-1000 side-to-side difference of 3 mm or less.REVIEW1234THANK YOU!
