Repair of acute medial collateral ligament injury of knee joint

Acute knee medial collateral ligament injury repair for surgical treatment of medial collateral ligament injury. Medial collateral ligament injury is the most common knee ligament injury, which occurs mostly in the knee flexion position, excessive rotation, especially with valgus stress. The medial collateral ligament tear can occur in any part and is divided into 6 types according to pathological changes. The most common site is at the attachment of the tibia or tibia, the shallow layer is avulsed at the attachment of the tibia, and the deep layer is avulsed at the femoral attachment, or vice versa. The middle segment of the ligament is less likely to be torn. The most common type of clinically is the shallow layer of the proximal femoral condyle with a fracture piece, and the deep layer of the distal tibial condyle. Because the medial collateral ligament is very important for knee joint stability, any person with complete fracture, whether or not combined with other injuries, should be repaired. Treatment of diseases: knee collateral ligament injury Indication Acute knee medial collateral ligament injury repair is suitable for complete rupture of the medial collateral ligament, or complete rupture of the collateral ligament with meniscus injury, cruciate ligament rupture, and intercondylar uplift fracture. Preoperative preparation Anesthesia and position Spinal or epidural anesthesia is generally used. The patient was placed in the supine position with the medial knee on the upper side, the hip flexed 45°, and the knee flexed 60°. Surgical procedure 1. Incision S-shaped incision in the medial aspect of the knee joint, starting from the upper iliac crest of the femur 2cm, slightly curved down through the adductor nodules, parallel to the tibia and patellar ligament 3cm, ending in the medial aspect of the humerus 5~6cm . 2, revealing the inner structure Cut the skin and subcutaneous tissue according to the direction of the incision, and separate the posterior flap to protect the saphenous vein and saphenous nerve. The deep fascia was dissected to reveal the medial collateral ligament. The knee valgus stress test was performed under direct vision to observe the instability of the ligament. The medial extensor support band is cut longitudinally along the anterior edge of the sartorius muscle from the posterior medial angle of the sarcophagus. Be careful not to cut the humeral stop of the deep medial collateral ligament. The knee flexion retracts the structure of the sartorius muscle and the goose foot, and examines the medial collateral ligament sacral stop, which is located deep and distal to the sartorius muscle. If the anterior longitudinal ligament is not broken, but there is a hematoma or blood stasis, it means deep ligament injury. The shallow layer should be cut at the attachment of the humerus and turned to the proximal end. At this time, the posterolateral medial collateral ligament and medial collateral ligament, The semimembrane muscle complex was completely exposed and pathological changes were observed. 3, explore the knee joint If the collateral ligament rupture is found, the medial joint capsule is cut open in the medial part of the patellar tendon and the quadriceps tendon joint to remove the hematoma, and the meniscus and anterior cruciate ligament are not torn, and the articular cartilage is damaged. 4. Repair of the medial joint capsule structure The medial joint capsule complex, the oblique ligament or the semimembranosus complex tear should be repaired first, depending on the type of tear. At both ends of the torn ligament, multiple threads can be sutured intermittently, and the suture can be reinforced with a twisted suture. If the posteromedial posterior oblique ligament complex is avulsed from its femoral attachment, it can be sutured with 2-0 or 3-0 silk suture and passed through the joint capsule and posterior oblique ligament humerus to fix it to the ligament of the posterior humerus. remote. Knee flexion 60°, the posterior oblique ligament is tightened as far as possible, and the adductor muscle nodules are fixedly tied. The posterior oblique ligament tendon is pulled forward and sutured to the posterior border of the periosteum and the repaired medial collateral ligament. The posterior edge of the posterior oblique ligament is sutured to the posterior border of the medial collateral ligament 5, repair the medial collateral ligament All parts of the medial collateral ligament should be repaired one by one. When the medial collateral ligament, the medial ligament of the medial joint capsule, and the femoral attachment of the posterior oblique ligament have avulsion fractures, the fractures are larger with or without fractures, and the femoral ligament is attached to the femoral ligament. 2cm × 1cm × 1cm shallow bone groove, the front and rear edges of the bone groove are drilled 2 holes, and the ligament ends are fixed in the bone groove with silk thread. 6, the treatment of concurrent anterior cruciate ligament injury If there is a anterior cruciate ligament tear, in addition to the difficulty in repairing the middle segment, the proximal or distal end should be repaired (see the anterior cruciate ligament injury for repair), and the ligation can only be tightened after the medial collateral ligament is completely repaired. 7. Treatment of concurrent medial meniscus injury If the medial meniscus marginal tear is combined, suture can be feasible; if the heavier tear has reached the meniscus, the meniscus should be partially or completely removed, and then the collateral ligament should be repaired. 8. Treatment of humeral external malleolus fracture or lateral meniscus injury First, make a longitudinal incision on the outside of the knee, repair the fracture and explore the meniscus, and then repair the medial collateral ligament. 9, suture incision and external fixation After the ligament is repaired, loosen the tourniquet, completely stop the bleeding, rinse the incision with isotonic saline, and suture layer by layer. The knee joint is flexed and the long leg plaster support is fixed.