Medial Collateral Ligament Attachment Transposition

Transposition of medial collateral ligament attachment 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. In the past, the use of static repair, that is, the repair of the injured ligament with the semitendinosus tendon, the gracilis tendon or the fascia lata near the knee joint, or the displacement of the ligament at the relaxation of the ligament, enhance the tension and improve the lateral stability. . The effect of static repair is not long-lasting, and it is still good in the near future. It has become slack for a long time and gradually loses the surgical effect. To this end, someone has designed a dynamic repair, the typical procedure is the goose foot shift, applying the attachment points of the semitendinosus, semimembranosus and sartorius muscles outwards and upwards, providing dynamic eversion, advancement and rotation. Stability. The symptoms improved significantly after the operation, but objectively examined the medial collateral ligament still has varying degrees of relaxation. Treatment of diseases: knee collateral ligament injury Indication The medial collateral ligament attachment displacement is suitable for medial collateral ligament injury. Intraoperative exploration revealed that there is continuity in ligament relaxation. Surgical procedure 1. Lateral collateral ligament 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 . The trailing edge and its attachment are exposed. 2. Transposition of the upper collateral ligament If the incision is insufficient, extend it properly, then cut the bone block (2cm × 2cm) connected to the ligament, straighten the knee joint and adduct the calf, and pull the medial collateral ligament to the proximal end, 20°30° The ligament is placed in the upper part of the anterior ligament attachment portion to make the ligament maintain a tight state, and is cut into a bone groove of the same size as the upper bone block. The bone piece is embedded in the bone groove and fixed by a screw. 3. Treatment of medial meniscus injury If the medial meniscus injury is suspected, use the force to abduct the thigh after the bone is opened, widen the medial joint space, explore the meniscus, and repair or resect. 4. Stitching and fixing The incision was sutured, the tourniquet was loosened by external fixation, the bleeding was completely stopped, the incision was washed with isotonic saline, and the subcutaneous tissue and skin were sutured layer by layer. The knee flexes from 20° to 30° and is fixed with long leg tubular cast.