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AnteriorCruciateLigament

Injury

HanGuibinorthopaedicsdepartmentHaikoumunicipalpeople’shospitalAnteriorCruciateLigamentInj1MEDICALTERMSanteriorcruciateligament（ACL）femoralcondylarnotchsynoviumeversioninversiongraftpatellartibialplateau前交叉韌帶股骨髁間窩滑膜外翻內(nèi)翻移植物髕骨的脛骨平臺MEDICALTERMSanteriorcruciate2INCIDENCEIthasbeenestimatedthat100,000anteriorcruciateligamentsaretorneachyearintheUnitedStates.

RISKFACTORSgender:femaleoccupation:athletetheintercondylarnotchwidthindex:lowerindexEPIDEMIOLOGYINCIDENCERISKFACTORSEPIDEMIO3ANATOMY

Originatesfromthelateralfemoralcondylewithinthecondylarnotchandinsertsonthetibialplateau.31to35mminlengthand31.3mm2incrosssection.Atwo-bundleligament,consistingofasmallanteromedialandalargerposterolateralbundle.Surroundedbysynovium.sideelevationfinitegraphfrantelevation

ANATOMYOriginatesfromthela4PATHOGENESISContactinjuryEversionInversion

HyperextendedAnteriorandposterior

remotionNoncontactinjuryDecelerationinjumping,orcuttingaction

PATHOGENESISContactinjury5SYMPTOMSAnaudiblepoporcrackAfeelingofinitialinstabilityExtremepainDysfunctionSYMPTOMSAnaudiblepoporcrac6limitedrangeofmotionSwelling&tendernessanteriordrawertestpivotshifttestfloatingpatellatestLachmantestSIGNSlimitedrangeofmotionSwellin7INVESTIGATIONSgoldenstandardsensitiveeffective

ineffectivearthroscopeMRI、KT-1000ultrasonography、CTX-rayINVESTIGATIONSgoldenstandards8TREATMENTolderpeoplewillingtomakelifestylechangesavoidtheactivitiesthatcauserecurrentinstabilityagelifestyleoccupationdegreeofkneeinstabilityassociatedinjuriesyoungerpeopleregularlyplayssportlikelytoadheretoacomplexrehabilitationprogramDecisionfactorsNonoperativetreatmentSurgicaltreatmentTREATMENTolderpeopleageyoun9SurgicaltreatmentRepairRepairwithaugmentationReconstructionSURGICALTREATMENTSurgicalRepairRepairwithRecon10

extraarticularprocedurescombinedinstabilitiesintraarticularproceduresarthroscopictechniquesClicktoignoretwoslidesaboutoperationdetailsRECONSTRUCTIONTECHNIQUEextraarticularcombine11ARTHROSCOPYTECHNIQUEOFACLRECONSTRUCTIONHarvestingtheGraftPreparingtheGraftDrillingthetibialtunnelDrillingtheFemoraltunnelPullingthegraftinplaceFemoralFixationTibialFixationARTHROSCOPYTECHNIQUEOFACLR12ACARTOONOFACLRECONSTRUCTIONACARTOONOFACLRECONSTRUCTIO13COMPLICATIONSOFACLSURGERY1appropriatetimingofsurgery;adequatepreoperativeconditioningandstrengthening;graftandfixationchoices2

patellarfracture,inadequategraftlength,mismatchbetweentheboneplugandtunnelsizes,graftfracture,suturelaceration,violationoftheposteriorfemoralcortex,andincorrectfemoralortibialtunnelplacement3motion(primarilyextension)deficitspersistentanteriorkneepainpreoperativeintraoperative

postoperative

COMPLICATIONSOFACLSURGERY1a14PROGNOSISnonoperativeAfterameanfollow-upof7years,83%weresatisfiedwiththeresults.repairResearchersconcluded:anonaugmentedprimaryrepairshouldnotbedone;repairwithaligamentaugmentationhadanunacceptablyhighfailurerate.reconstructionMostcurrentstudiesreporta90%to95%successrateinrestoringstabilityasdefinedbyaKT-1000side-to-sidedifferenceof3mmorless.PROGNOSISnonoperativeAfteram15REVIEWepidemiology1anatomy2investigations3treatment4REVIEWepidemiology1anatomy2inv16THANKYOU!THANKYOU!17AnteriorCruciateLigament

Injury

HanGuibinorthopaedicsdepartmentHaikoumunicipalpeople’shospitalAnteriorCruciateLigamentInj18MEDICALTERMSanteriorcruciateligament（ACL）femoralcondylarnotchsynoviumeversioninversiongraftpatellartibialplateau前交叉韌帶股骨髁間窩滑膜外翻內(nèi)翻移植物髕骨的脛骨平臺MEDICALTERMSanteriorcruciate19INCIDENCEIthasbeenestimatedthat100,000anteriorcruciateligamentsaretorneachyearintheUnitedStates.

RISKFACTORSgender:femaleoccupation:athletetheintercondylarnotchwidthindex:lowerindexEPIDEMIOLOGYINCIDENCERISKFACTORSEPIDEMIO20ANATOMY

Originatesfromthelateralfemoralcondylewithinthecondylarnotchandinsertsonthetibialplateau.31to35mminlengthand31.3mm2incrosssection.Atwo-bundleligament,consistingofasmallanteromedialandalargerposterolateralbundle.Surroundedbysynovium.sideelevationfinitegraphfrantelevation

ANATOMYOriginatesfromthela21PATHOGENESISContactinjuryEversionInversion

HyperextendedAnteriorandposterior

remotionNoncontactinjuryDecelerationinjumping,orcuttingaction

PATHOGENESISContactinjury22SYMPTOMSAnaudiblepoporcrackAfeelingofinitialinstabilityExtremepainDysfunctionSYMPTOMSAnaudiblepoporcrac23limitedrangeofmotionSwelling&tendernessanteriordrawertestpivotshifttestfloatingpatellatestLachmantestSIGNSlimitedrangeofmotionSwellin24INVESTIGATIONSgoldenstandardsensitiveeffective

ineffectivearthroscopeMRI、KT-1000ultrasonography、CTX-rayINVESTIGATIONSgoldenstandards25TREATMENTolderpeoplewillingtomakelifestylechangesavoidtheactivitiesthatcauserecurrentinstabilityagelifestyleoccupationdegreeofkneeinstabilityassociatedinjuriesyoungerpeopleregularlyplayssportlikelytoadheretoacomplexrehabilitationprogramDecisionfactorsNonoperativetreatmentSurgicaltreatmentTREATMENTolderpeopleageyoun26SurgicaltreatmentRepairRepairwithaugmentationReconstructionSURGICALTREATMENTSurgicalRepairRepairwithRecon27

extraarticularprocedurescombinedinstabilitiesintraarticularproceduresarthroscopictechniquesClicktoignoretwoslidesaboutoperationdetailsRECONSTRUCTIONTECHNIQUEextraarticularcombine28ARTHROSCOPYTECHNIQUEOFACLRECONSTRUCTIONHarvestingtheGraftPreparingtheGraftDrillingthetibialtunnelDrillingtheFemoraltunnelPullingthegraftinplaceFemoralFixationTibialFixationARTHROSCOPYTECHNIQUEOFACLR29ACARTOONOFACLRECONSTRUCTIONACARTOONOFACLRECONSTRUCTIO30COMPLICATIONSOFACLSURGERY1appropriatetimingofsurgery;adequatepreoperativeconditioningandstrengthening;graftandfixationchoices2

patellarfracture,inadequategraftlength,mismatchbetweentheboneplugandtunnelsizes,graftfracture,suturelaceration,violationoftheposteriorfemoralcortex,andincorrectfemoralo

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