The Anatomical Significance Of Arthroscopic Reconstruction For Anterior Cruciate Ligament Reconstruction

The anatomical reconstruction technology of anterior cruciate ligament(ACL)is a technology formed with the development of ACL anatomical theory.The functional reconstruction is implemented through the anatomical structure characteristics of ACL,so that the repaired ACL size is restored to the original size,the running direction of ACL is restored to be consistent with the original running direction,and the position of ACL stop is restored.Non anatomical isometric reconstruction,single beam reconstruction and double beam reconstruction are three methods of anatomical reconstruction.This study aims to explore the ideal medical effects of non anatomical isometric reconstruction,anatomical single bundle reconstruction,anatomical double bundle reconstruction and anatomical plus isometric reconstruction of anterior cruciate ligament under arthroscopy.Methods: all four groups were under epidural anesthesia.The patient is in a supine position with his knees bent at right angles.Apply the electric tourniquet to the patient’s inner thigh to stop bleeding,and then place it on the special surgical leg frame.Firstly,knee arthroscopy(Stryker company,4.0mm,30 ° knee arthroscopy)should be used for basic examination of the knee joint.If there is a patient with meniscus injury,the patient should be corrected according to the corresponding conditions.All four groups used electric drill to eliminate the residual tissue of Subpatellar fold and anterior cruciate ligament under knee arthroscopy.Preparation of anterior cruciate ligament grafts: a 4cm long incision was made at 1cm inside the tibial tubercle in all four groups to partially expose the semitendinosus and gracilis tendon.Fold the tendons into 4 strands,each about 10 cm long.Use No.2 non absorbable suture on both sides for surgical suture,and keep the suture on both sides.Measure after suture to ensure that the diameter of hamstring tendon is between 8 ～ 9mm,and pretension it for standby.Establishment of tibial tunnel: all four groups locate and fix the scale to 55 °through the scale on the dial of tibial guide,and set the aiming point at 2mm in the core of tibial end stop of anterior cruciate ligament and both sides of the extension line of meniscus dispersion edge.In the coronal position,it tilts 20 ° to both sides.According to the diameter of reconstructed tendon,a tibial tunnel was selected with a medium sized twist drill.The ACL reconstruction methods:In the non anatomical group,the traditional single bundle ACL reconstruction method was used: in the non anatomical group,the center of gravity of the intercondylar fossa was 10:30(right knee)or 1:30(left knee)about 6 mm away from the bone cortex of the intercondylar fossa.Create femoral tunnel: bend the knee joint at an angle of 90 degrees,place a guide with an eccentricity of 6 mm at the tibial tunnel,drill the guide needle to the entrance point of ACL femoral tunnel,select 4.5 mm hollow drill,and drill the femoral tunnel to the epithelium outside the femur.If the length of the femoral tunnel is greater than 3.6 cm,A hollow ring drill of the same size can be used to drill a tunnel with a depth of about 2.8 cm at the precise position of the femoral end.The guide needle with groove at the needle tail can enter through the femoral tunnel from the tibial tunnel to the surrounding femoral tunnel and penetrate the skin through the external condyle of the femur.Anatomic group 1 selected anatomic single bundle reconstruction ACL operation method: the patient was lying on his back,his knees were bent,and his legs were naturally drooping.Create a basic anterolateral and anterolateral approach next to the patellar tendon.Check the articular cavity in order to determine the location of ACL fracture.Make an oblique incision of about 3cm on the inner side of the tibial tubercle,expose the gracilis and semitendinosus,take them out,keep their integrity,and finally prepare them into 4 strands as grafts.The medial meniscus of the far lateral approach(first insert the guide needle for accurate positioning,and require the guide needle to be on the upper side of the patellar tendon)can be adjusted according to the position of the medial and lateral condyles of the femur.The femoral insertion of ACL successfully reached the predetermined position directly forward.The bending angle of the knee joint is 110 ～ 120 °,the lateral walls on both sides of the femoral intercondylar fossa are monitored through the anterolateral approach,the precise positioning guide needle is inserted through the far lateral approach,and the two lateral walls of the femoral intercondylar fossa are observed through the anterolateral approach to determine whether the guide needle is inserted accurately.The femoral tunnel was drilled and measured with a hollow drill of appropriate size along the guide pin.The ACL tibial locator was used to accurately locate the tibial insertion point through the anteromedial approach,and the tibial tunnel was basically formed.The graft was placed into the tibial tunnel.The proximal end was fixed with endobuton suspension plate of appropriate length,and the distal end was fixed with extrusion screw.Determine the transplantation site,supporting force and whether there is collision.The joint cavity was cleaned,the wound was sutured and pressure bandaged.Anatomical group 2 used anatomical double bundle ACL reconstruction method:when making the graft used for double bundle ACL reconstruction,double krackow suture technology needs to be applied.The method is to suture the two ends of semitendinosus tendon and gracilis tendon with double krackow suture technology through Johnson & Johnson Ethibond 2.0 non absorbable suture.The tendon was sutured into 2 strands,the gracilis tendon was used as the posterior external bundle and the semitendinosus tendon was used as the anterior internal bundle,and the length and diameter were accurately measured.Generally,the shortest length of the rear side is5.5cm,and the length of the left front inner side is 6.5cm;The diameter of the rear two sides is 5 ～ 6mm,and the diameter of the front inner side is 6 ～ 7mm.The ACL reconstruction method with the same anatomical length was used in the anatomical three groups: the medial parapatellar low wound was embedded into the knee arthroscopy as the knee arthroscopy channel,and the intercondylar fossa was not osteoplasty.The ideal femoral entry point is 3mm below the physician’s crest about6 mm at the cortical edge of the posterior condyle.The ideal femoral point of the anterior cruciate ligament is marked with microwave radiofrequency scalpel.Make another 2cm incision inside the patella to form the femoral tunnel.Drill the femoral tunnel to the outer superior cortex of the femur with a hollow ring drill with a diameter of 4.5mm,and accurately measure the length of the femoral tunnel.If it is greater than 3.6cm,use a hollow ring drill with the same diameter as the tendon to drill a tunnel with a depth of about 2.8cm at the femoral end along the positioning needle,The femoral end tendon can use the ring length of 15 mm titanium alloy plate(endobuton),use the slotted guide wire of the needle tail to guide the wire from the femoral tunnel,and use the wire clamp to lead the wire out of the tibial tunnel.Under the monitoring of knee arthroscopy,the steel wire traction belt transplanted the tendon according to the tibial and femoral tunnel,screwed the digestible and absorbable compression screw into the femoral end,and fixed the immobile tendon or endobuton fixed tendon.Tighten the tail extension line,continuously extend and bend the knee joint,adjust the support force of the prosthesis,and check under the knee arthroscope to confirm that there is no collision between the top wall of the intercondylar fossa and the bilateral walls and the reconstructed anterior cruciate ligament.Under 30 ° knee bending,the compression screw was passed through the tibia to check the reliability of anterior cruciate ligament reconstruction,and the wound placement and drainage methods were basically closed for compression bandage.Results: 1.arthroscopic reconstruction of knee ACL fracture patients related examination results: A.intraoperative arthroscopy showed that the idealized P point of femoral tunnel was 6 mm away from the posterior wall of intercondylar fossa and 3mm below the cliff of residents.B.Postoperative three-dimensional CT reconstruction showed that the femoral tunnel was located at the ideal site.C.Postoperative MRI showed that the signal of anterior cruciate ligament was normal,the included angle of anterior cruciate ligament was 55 °,blumensaat angle was 18 °.D.The included angle of posterior cruciate ligament is 122 °,and the posterior cruciate ligament index is 0.28.E.The lateral tibial plateau moved forward 0 mm.2.Comparison of different methods of ACL reconstruction in four groups under arthroscopy: the four groups were followed up for 18 ～ 30(24 ± 6)months.The postoperative wound healing was good,and there was no intra-articular sensation,nerve injury,lower extremity deep venous thrombosis and capillary injury.The grafts used were semitendinosus and gracilis tendons of the patients themselves.3.Under arthroscopy,the four groups used different methods to reconstruct ACL.The traditional non anatomical ACL reconstruction surgery is suitable for the initial stage of ACL reconstruction surgery.There will still be rotational instability in the reconstructed knee joint.Anatomic single bundle reconstruction under knee arthroscopy can repair most of the functions of ACL middle bundle and anterior internal bundle,but reduce some relaxation under knee extension,and the rotational stability of external bundle function can not be repaired and reconstructed.The effect of anatomical double bundle reconstruction under knee arthroscopy is significantly higher than that of single bundle reconstruction in improving the stability of knee joint.The cruciate ligament of the knee was reconstructed by anatomy and equal length under knee arthroscopy,which improved the stability of the knee after operation.Conclusions:1.Anatomic single bundle reconstruction under knee arthroscopy can repair most of the functions of ACL middle bundle and anterior internal bundle,but the rotational stability of external bundle function cannot be repaired and reconstructed.The effect of anatomical double bundle reconstruction is significantly higher than that of single bundle reconstruction in improving the stability of knee joint.the ideal reconstruction of anterior cruciate ligament with hamstring tendon under knee arthroscopy is the best method to repair the anteroposterior and rotational stability of knee joint.2.Arthroscopic anatomy + isometric reconstruction of the anterior cruciate ligament of the knee improves the stability of the knee after operation,suggesting that arthroscopic anatomy + isometric reconstruction of ACL is a reliable method to repair the forward and backward movement and rotation stability of the knee when treating ACL fracture.