[Artroskopická náhrada predního zkrízeného vazu volným stepem z ligamentum patellae transtibiální technikou.].
Surgical techniques of replacement of the anterior cruciate ligament were further developed in recent years. In the submitted paper the authors describe arthroscopic replacement of the anterior cruciate ligament by transtibial technique of a single incision with an incomplete femoral canal. The objective of the work is to test, based on the authors' own shortterm experience, the reliability and contribution of this technique and possibly correct it with regard to the assembled results and experience. Main emphasis was laid on evaluation of the range of mobility, stability and X-ray evaluation of the localization of the femoral and tibial canal and the femoral interference screw. During evaluation the recommendations of IKDC were respected. For evaluation of the anterior translation of the tibia (Lachman's test) an arthrometer KT 1000 was used. For X-ray evaluation of the site of the intraarticular orifice of the tibial and femoral canal the authors used Harrier's method and for evaluation of impingement of the graft on the ceiling of the intercondylar space Howell's method. A total of 32 patients were checked, all operated by this technique in 1994. The mean age of the patients at the time of operation was 24 years (16-40). The mean follow up period after surgery is 9 months (6-18 months). In all a graft from the patellar ligament was used, fixed to the femur by an interference screw, to the tibia by an interference screw in 26 patients. In 6 patients the graft was fixed by a hook. 94% of the patients evaluated the function of the operated knee as normal or almost normal. In 28 patients extension and in 30 flexion was without restriction. Two of the four patients with restricted extension, pain and oedema were subjected to repeated arthroscopy with the diagnosis "cyclops" syndrome. When evaluating the anterior translation of the tibia by an arthrometer KT 1000 (134 N, by maximal manual force) in 24 patients the difference was less than 3 mm, in 7 it was 3-5 mm and in one more than 5 mm. The pivot shift test was positive (1+) only in one patient. The required intraarticular orifice of the tibial canal (into section B according to Harner) was achieved in 87.5% patients and optimal centering of the femoral canal (into section D according to Harner) in 56% patients. In the remainder the femoral canal was in a slightly more ventral position (it reached as far as section C, on average by 2 mm). Slight impingement according to Howell was found in 4 patients. In 28 patients the femoral interference screw was inserted parallely, in three patients the divergence was 10-20 degrees and in one 35 degrees . The described technique reduces the risk of impingement of the graft on the ceiling of the intercondylar space. Correct orientation of the femoral canal and faultless insertion of the femoral interference screw calls for adequate experience. For orientation and drilling of the femoral canal optimal flexion is 80 degrees . The greatest surgical trauma is taking the graft from the patellar ligament. The method promotes more rapid rehabilitation. Key words: anterior cruciate ligament, arthroscopic replacement, transtibial technique.
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Ortopedická klinika IPVZ, FN Bulovka, Praha.
Adamco
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Stasa
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