Primary Multiple Ligament Repair in Traumatic Knee Dislocation: Case Report

Yıl 2017, Cilt: 9 Sayı: 1, 41 - 50, 01.03.2017

Orhan Balta Murat Aşcı Harun Altınayak Bora Bostan

Öz

In this article, clinical, radiological and functional
results of primary repair of medial tibial plateau fracture, deep and
superficial MCL (medial collateral ligament) rupture, ACL (anterior cruciate
ligament), ACB (posterior cruciate ligament) and medial meniscus rupture are
reported. A 26-year-old female patient admitted to our clinic with complaints
of swelling and pain in the left knee resulting from falling from the bicycle.
The knee motion of the patient with knee effusion was restricted and painful.
In the case of the patient without neurovascular pathology, the forward drawer
and the back drawer tests were positive. Also grade 3 opening was present on the
medial side of the valgus stratum. Radiological examinations revealed medial
tibial plateau fracture, deep and superficial MCL rupture, rupture of the ACL
and ACL, and rupture of the medial meniscus.During surgery, the plateau
fracture was first detected with a medial longitudinal incision with headless
screws. The deep and superficial MCL are finished with a fully stitched anchor
and post screw. Parapatellar arthrotomy was performed using a midline
longitudinal incision. It was seen that the anterior part of the medial
meniscus had been broken and that it was disconnected from the femoral
attachment site of the ACL and the tibial attachment site of the ACL. Krackow
sutures from the ICU were passed through and one femoral anchor was fixed
instead of femoral adhesion. In the ACL, Krackow sutures were passed and
pull-out technique was used. Medial meniscus anterior horn was repaired with 1
anchor. After 6 weeks, the load was loaded and the ROM started. However,
arthroscopic arthroplasty was performed at 8 weeks due to limited knee motion.
The arthroscopic examination revealed that the ACL, ACL, and medial meniscus
were healed. In general, acute repair results are better than chronic
reconstructions. In such cases, intensive rehabilitation is needed and only good
rehabilitating patients can get good results. In this paper, We believe that
multiple ligament injuries are successful following 18 month follow-up of
simultaneous primer repair.

Anahtar Kelimeler

Knee dislocation, multiple ligament rupture, primary repair

Travmatik Diz Çıkığında Multipl Primer Bağ Onarımı: Olgu Sunumu

Öz

Bu yazıda medial tibial plato kırığı, derin ve yüzeyel
MCL(medial kollateral ligaman) rüptürü, ÖÇB(ön çapraz bağ), AÇB(arka çapraz
bağ) ve medial menisküs yırtığı olan hastaya uygulanan primer tamirlerin
klinik, radyolojik ve fonksiyonel sonuçları bildirilmektedir.26 yaşında kadın
hasta bisikletten düşme sonucu sol dizinde gelişen şişlik ve ağrı şikayeti ile
kliniğimize başvurdu. Yapılan muayenesinde dizinde efüzyon olan hastanın diz
hareketleri kısıtlı ve ağrılı idi. Radyolojik tetkiklerinde medial tibial plato
kırığı, derin ve yüzeyel MCL rüptürü, AÇB ve ÖÇB rüptürü ve medial menisküs
yırtığı saptandı.Cerrahi sırasında öncelikle medial longitudinal insizyonla
plato kırığı başsız vidalarla tespit edildi. Derin ve yüzeyel MCL tamiri
dikişli çapalar ve post vidası ile tamamlandı. Sonrasında midline longitudinal
insizyon kullanılarak parapatellar artrotomi yapıldı. Medial menisküsün ön kök
kısmının kopmuş olduğu, AÇB'ın femoral yapışma yerinden, ÖÇB'ın ise tibial
yapışma yerinden kopmuş olduğu görüldü. AÇB’dan Krackow sütürler geçilerek bir
adet düğümsüz çapa ile femoral yapışma yerine tespit edildi. ÖÇB ise Krackow
sütürleri geçilerek pull-out tekniği ile tespit edildi. Medial menisküs ön
boynuzu ise 1 adet çapa ile tamir edildi. 6. haftadan sonra tedrici olarak yük
ve ROM başlandı. Ancak diz hareketinin kısıtlı kalması nedeni ile 8. haftada
artroskopik artroliz yapıldı. Genel olarak akut tamir sonuçları, kronik
rekonstrüksiyonlardan daha iyidir. Bu tür vakalarda yoğun rehabilitasyon
gerekmekte ve ancak uygun rehabilite edilen hastalarda yüz güldürücü sonuçlar
alınabilmektedir. Bu yazıda sunulan vakada; multiple bağ yaralanmalarının eş
zamanlı primer tamirinin 18 aylık takibi sonucunda başarılı olduğunu düşünmekteyiz.

Anahtar Kelimeler

Diz çıkığı, multipl ligamant rüptürü, primer onarım

Kaynakça

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