Application of transosseous suture <i>in situ</i> technique in repair of anterior cruciate ligament for multiple ligament injuries with knee dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MAO Yunhe , TANG Jiexi ,  LI Jian , TANG Xin , LI Qi

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

LI Jian, Email: hxlijian.china@163.com

Keywords：

Knee joint; multiple ligament injuries with knee dislocation; anterior cruciate ligament avulsion injury; transosseous suture in situ; arthroscopy

DOI：

10.7507/1002-1892.201907075

Video：

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Objective To investigate the method and effectiveness of transosseous suture in situ technique in repairing anterior cruciate ligament (ACL) avulsion injury for the multiple ligament injuries with knee dislocation (MLIKD).Methods The clinical data of 27 patients (27 knees) with MLIKD between September 2010 and April 2016 were analyzed retrospectively. There were 21 males and 6 females, with an average age of 42 years (range, 24-60 years). The injury was caused by traffic accident in 9 cases, heavy-weight crushing in 9 cases, sports sprain in 6 cases, falling from height in 3 cases. The interval from injury to operation was 1-19 days (mean,10.8 days). There were 20 cases of femoral avulsion injury of ACL, 7 cases of tibial avulsion injury of ACL, and there were 17 cases of posterior cruciate ligament (PCL) injuries. According to the Schenck classification, there were 15 cases of KD-Ⅲ-M type, 8 cases of KD-Ⅲ-L type, and 4 cases of KD-Ⅳ type. All patients were positive in the posterior drawer test and Lachman test; 8 cases were degree Ⅲ positive in varus stress test, and 15 cases were degree Ⅲ positive in valgus stress test. The Lysholm score of knee was 27.6±6.5, the International Knee Documentation Committee (IKDC) score was 25.5±6.2, and the range of motion (ROM) of knee was (45.1±10.2)°. The injured PCL was reconstructed with a single bundle of autologous hamstring tendon. ACL was repaired with double bundle traction by transosseous suture in situ technique. Medial cruciate ligament, lateral cruciate ligament, joint capsule, and other damaged structures were repaired at the same time.Results All incisions healed by first intention. There were 3 cases with joint effusion and 3 cases with incomplete flexion. All patients were followed up 12-36 months (mean, 22 months). The X-ray films showed good stability in all directions. At last follow-up, the anterior and posterior drawer tests were all negative; Lachman test was degreeⅠpositive in 4 cases, valgus stress test was degreeⅠpositive in 3 cases, varus stress test was degreeⅠpositive in 1 case; and all tests were negative in the rest patients. At 1 year after operation, the ROM of knee was (119.3 ±12.6)°, Lysholm score was 87.2±6.3, and IKDC score was 87.9±6.3, showing significant differences when compared with the preoperative scores (P<0.05).Conclusion Transosseous suture in situ technique can be used to repair the ACL avulsion injury for MLIKD, which can significantly improve the stability, mobility and function of the knee joint, and obtain satisfied short-term effectiveness.

Citation： MAO Yunhe, TANG Jiexi, LI Jian, TANG Xin, LI Qi. Application of transosseous suture in situ technique in repair of anterior cruciate ligament for multiple ligament injuries with knee dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 190-195. doi: 10.7507/1002-1892.201907075 Copy

1.	Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
2.	McKee L, Ibrahim MS, Lawrence T, et al. Current concepts in acute knee dislocation: the missed diagnosis? Open Orthop J, 2014, 8: 162-167.
3.	Lachman JR, Rehman S, Pipitone PS. Traumatic knee dislocations: evaluation, management, and surgical treatment. Orthop Clin North Am, 2015, 46(4): 479-493.
4.	錢利海, 梁清宇, 陳先進, 等. 膝關節脫位合并多發韌帶損傷的治療策略及療效分析. 中華解剖與臨床雜志, 2016, 21(6): 552-557.
5.	Ateschrang A, Schreiner AJ, Ahmad SS, et al. Improved results of ACL primary repair in one-part tears with intact synovial coverage. Knee Surg Sports Traumatol Arthrosc, 2019, 27(1): 37-43.
6.	姚俊娜, 王洪剛, 權松濤, 等. 關節鏡下縫合線橋內固定技術治療青少年前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2018, 32(11): 1402-1405.
7.	吳冰, 丘志河, 李盛, 等. 自體腘繩肌腱移植重建前交叉韌帶后移植物的組織學研究. 中國修復重建外科雜志, 2018, 32(7): 873-879.
8.	Schenck RC Jr. The dislocated knee. Instr Course Lect, 1994, 43: 127-136.
9.	Schenck RC Jr. Classification of knee dislocations. Oper Tech Sports Med, 2003, 11(3): 193-198.
10.	Krackow KA, Thomas SC, Jones LC. Ligament-tendon fixation: analysis of a new stitch and comparison with standard techniques. Orthopedics, 1988, 11(6): 909-917.
11.	Wilson SM, Mehta N, Do HT, et al. Epidemiology of multiligament knee reconstruction. Clin Orthop Relat Res, 2014, 472(9): 2603-2608.
12.	Wascher DC, Becker JR, Dexter JG, et al. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med, 1999, 27(2): 189-196.
13.	Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy, 1996, 12(5): 521-530.
14.	Mariani PP, Santoriello P, Iannone S, et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg, 1999, 12(4): 214-221.
15.	Owens BD, Neault M, Benson E, et al. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma, 2007, 21(2): 92-96.
16.	Kohl S, Stock A, Ahmad SS, et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury, 2015, 46(4): 724-728.
17.	Wang R, Xu B, Xu HG. Up-regulation of TGF-β promotes tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells through the TGF-β/MAPK signaling pathway in a New Zealand white rabbit model. Cell Physiol Biochem, 2017, 41(1): 213-226.
18.	Mutsuzaki H, Fujie H, Nakajima H, et al. Effect of calcium phosphate-hybridized tendon graft in anatomic single-bundle ACL reconstruction in goats. Orthop J Sports Med, 2016, 4(8): 2325967116662653.
19.	Irarrázaval S, Masferrer-Pino A, Iba?ez M, et al. Does anatomic single-bundle ACL reconstruction using hamstring autograft produce anterolateral meniscal root tearing? J Exp Orthop, 2017, 4(1): 17.
20.	Oka S, Matsumoto T, Kubo S, et al. Local administration of low-dose simvastatin-conjugated gelatin hydrogel for tendon-bone healing in anterior cruciate ligament reconstruction. Tissue Eng Part A, 2013, 19: 1233-1243.
21.	Chen CH, Liu HW, Tsai CL, et al. Photoencapsulation of bone morphogenetic protein-2 and periosteal progenitor cells improve tendon graft healing in a bone tunnel. Am J Sports Med, 2008, 36(3): 461-473.
22.	Moatshe G, Chahla J, Brady AW, et al. The influence of graft tensioning sequence on tibiofemoral orientation during bicruciate and posterolateral corner knee ligament reconstruction: A biomechanical study. Am J Sports Med, 2018, 46(8): 1863-1869.
23.	Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc, 2011, 19(2): 162-166.
24.	Chhabra A, Cha PS, Rihn JA, et al. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 1-21.

1. Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
2. McKee L, Ibrahim MS, Lawrence T, et al. Current concepts in acute knee dislocation: the missed diagnosis? Open Orthop J, 2014, 8: 162-167.
3. Lachman JR, Rehman S, Pipitone PS. Traumatic knee dislocations: evaluation, management, and surgical treatment. Orthop Clin North Am, 2015, 46(4): 479-493.
4. 錢利海, 梁清宇, 陳先進, 等. 膝關節脫位合并多發韌帶損傷的治療策略及療效分析. 中華解剖與臨床雜志, 2016, 21(6): 552-557.
5. Ateschrang A, Schreiner AJ, Ahmad SS, et al. Improved results of ACL primary repair in one-part tears with intact synovial coverage. Knee Surg Sports Traumatol Arthrosc, 2019, 27(1): 37-43.
6. 姚俊娜, 王洪剛, 權松濤, 等. 關節鏡下縫合線橋內固定技術治療青少年前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2018, 32(11): 1402-1405.
7. 吳冰, 丘志河, 李盛, 等. 自體腘繩肌腱移植重建前交叉韌帶后移植物的組織學研究. 中國修復重建外科雜志, 2018, 32(7): 873-879.
8. Schenck RC Jr. The dislocated knee. Instr Course Lect, 1994, 43: 127-136.
9. Schenck RC Jr. Classification of knee dislocations. Oper Tech Sports Med, 2003, 11(3): 193-198.
10. Krackow KA, Thomas SC, Jones LC. Ligament-tendon fixation: analysis of a new stitch and comparison with standard techniques. Orthopedics, 1988, 11(6): 909-917.
11. Wilson SM, Mehta N, Do HT, et al. Epidemiology of multiligament knee reconstruction. Clin Orthop Relat Res, 2014, 472(9): 2603-2608.
12. Wascher DC, Becker JR, Dexter JG, et al. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med, 1999, 27(2): 189-196.
13. Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy, 1996, 12(5): 521-530.
14. Mariani PP, Santoriello P, Iannone S, et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg, 1999, 12(4): 214-221.
15. Owens BD, Neault M, Benson E, et al. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma, 2007, 21(2): 92-96.
16. Kohl S, Stock A, Ahmad SS, et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury, 2015, 46(4): 724-728.
17. Wang R, Xu B, Xu HG. Up-regulation of TGF-β promotes tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells through the TGF-β/MAPK signaling pathway in a New Zealand white rabbit model. Cell Physiol Biochem, 2017, 41(1): 213-226.
18. Mutsuzaki H, Fujie H, Nakajima H, et al. Effect of calcium phosphate-hybridized tendon graft in anatomic single-bundle ACL reconstruction in goats. Orthop J Sports Med, 2016, 4(8): 2325967116662653.
19. Irarrázaval S, Masferrer-Pino A, Iba?ez M, et al. Does anatomic single-bundle ACL reconstruction using hamstring autograft produce anterolateral meniscal root tearing? J Exp Orthop, 2017, 4(1): 17.
20. Oka S, Matsumoto T, Kubo S, et al. Local administration of low-dose simvastatin-conjugated gelatin hydrogel for tendon-bone healing in anterior cruciate ligament reconstruction. Tissue Eng Part A, 2013, 19: 1233-1243.
21. Chen CH, Liu HW, Tsai CL, et al. Photoencapsulation of bone morphogenetic protein-2 and periosteal progenitor cells improve tendon graft healing in a bone tunnel. Am J Sports Med, 2008, 36(3): 461-473.
22. Moatshe G, Chahla J, Brady AW, et al. The influence of graft tensioning sequence on tibiofemoral orientation during bicruciate and posterolateral corner knee ligament reconstruction: A biomechanical study. Am J Sports Med, 2018, 46(8): 1863-1869.
23. Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc, 2011, 19(2): 162-166.
24. Chhabra A, Cha PS, Rihn JA, et al. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 1-21.

Chinese Journal of Reparative and Reconstructive Surgery

Application of transosseous suture in situ technique in repair of anterior cruciate ligament for multiple ligament injuries with knee dislocation

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