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anatomic arthroscopic technique modified Mac-intosh fascia lata by first mini

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Anatomic arthroscopic technique modified Mc intosh the Fascia Lata by first mini
 

 

 
Introduction
 
The rupture of the anterior cruciate ligament (LCAE) of the knee decreases the knee's ability to adapt to stress in the rotational movements. The patient may feel a sensation of instability of the knee, including during sports.
 
Repair by direct suture ligament experiencing a failure rate of 100%. Therefore ligament reconstruction techniques have developed for decades. Ligamentoplasty is the use of tissue from the patient (autograft), or on an organ donor (allograft) or artificial origin (synthetic). This fabric can be called transplant or transplant or neo ligament. On the own knee of a patient, 4 autologous transplant may be used: the quadriceps tendon, patellar tendon, hamstring tendons of hamstrings and Fascia Lata. Each operating technique ligament is characterized by the type and method of sampling, fixation to the bone and the anatomical site of fixation of the transplant.
 
The purpose of this article is to present the theoretical principles and practical technical development of that originally described by Mac intosh with a transplant of fascia lata.
 
theoretical principles
 
This choice of transplant is used in many decades is again topical in the light of recent knowledge anatomical, biomechanical and clinical. The sampling is done by mini skin first with a short length scar arthroscopy for intra articular part.
 
Type of transplant: the fascia lata is a fibrous web which extends on the outer side of the thigh.
Figure 1.
 
The transplant is removed in a strip of 15 to 18cm in length and from 15 to 35mm wide. It is left inserted on Gerdy's tubercle and prepped tubulis├ę a beam that makes 7 to 8 mm in diameter.
 
 
Figure 2.
 
It is stronger than the native anterior cruciate ligament.
 
Position of the transplant: the path of the transplant is both intra- and extra-articular. The instability is experienced by the patient corresponds to a translation and / or abnormal rotation of the tibia relative to the femur in the absence of LCAE.
 
This plasty combines anti anterior tibial translation effect of intra-articular plasty and anti rotary joint effect of an extra external plasty. With recent anatomical studies, we know that the LCAE has an anti anti translation and rotational behavior, which depends respectively antero posterior medial and lateral fibers. These fibers are distinct within the LCAE in terms of anatomical and biomechanical behavior. We talk about TWO beams of LCAE. With intra articular reconstruction placed instead of the medial anterior and another extra articular plasty, not anatomical this one, but that controls the rotation plasty in Fascia Lata meets the biomechanical application ligamentoplasty LCAE. For this, we place anatomically intra articular beam with a viewfinder outside and inside the femoral tunnel is said anatomical, and the tibial tunnel. For extra articular part, it is inspired by the side tenodesis described by Christel and Djian, derived from Lemaire technique. This second tuck is not known anatomical. For the intra-articular part, the tuck is placed on the anatomical site for a medial anterior beam LCAE.
 
 
Fixing the transplant:
 
After sampling, we realize two tunnels in the femur and tibia of the diameter measured on plasty usually 7 or 8 cm.
 
Figure 3.
 
Then the transplant happened in the femoral tunnel inwards and cycled. Then we fixed the transplant in the femur with an absorbable PLLA screw diameter of the tunnel, external rotation, 20 ┬░ of flexion.
  
The tibia is also fixed by a screw and a clip voltage dynamometer.
  
arthroscopy:
 
Control of the position of the tunnel and the passage of the transplant is by a camera placed on an optical placed in the joint.
 
 
practical principles
 
                  The steps of the surgical procedure which follow are:
 
- Review of the knee under anesthesia are tested laxity of internal ligaments, lateral, anterior and posterior cruciate both knees to be compared
 
- Knee Arthroscopy: one carries out a precise analysis articular cartilage, menisci two, and the rest of the ligament
 
- Sampling of the transplant: providing a first mini sideways to take the transplant
 
- Positioning of the transplant: a tunnel in the femur and tibia are made ??in the
 
- Fixing the transplant: the graft is secured by screws in tunnels
 
- Closure and drainage
 
- Testing the knee: it is verified that the preoperative laxity disappeared
 
- Immediate post operative care: anticoagulant injection
 
- The operative rehabilitation post is the subject of another article
 
 
Compared to other existing techniques
 
 
The comparison is made ??with 3 other current techniques for autologous neo ligament reference: technique of "hamstring" (hamstring), "Kenneth Jones" (Bone-patellar tendon-bone).
 
The main advantages are very good rotational control of the knee, the respect of the residual fibers LCAE, giving the qualities of proprioception, and compliance with hamstring hamstring or patellar tendon.
 
After the postoperative phase and wound healing, muscle recovery is very fast and allows a good rehabilitation.
The disadvantages are post operative slightly long and painful, many scars, the risk of postoperative hematoma.
 
Indications of this type of ligament
 
We reserve the right kind of intervention in case of a pivot practice sport at high level, a major rotational laxity or rupture of ligament.
           
 
 
Conclusion
 
The described technique allows ligamentoplasty LCAE anti translational and rotational anti control. This helps stabilize the knee in some directions that will be explained by your surgeon. Each knee of each patient requires appropriate ligament.
 

 

Doctor Yoann BOHU, Doctor Serge HERMAN, Doctor Nicolas LEFEVRE. - 28 janvier 2014.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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