Patent RU-2725971-C1 (RU)
Title: Method for surgical treatment of rupture of anterior cruciate ligament of knee joint
Inventor: SLASTININ VLADIMIR VIKTOROVICH
IPC: A61B17/56
Filed: 2019-11-08
Granted: 2020-07-07
Abstract: FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics in surgical treatment of knee joint injuries. Tear is diagnosed and partial remnants of an anterior cruciate ligament are removed. Four-beam autograft is formed from tendon of semitendinous muscle, wherein distal and proximal circular sutures are formed at distance from ends of autograft. Corrugatory sutures are formed on ends of autograft by transverse suturing of its bundles with subsequent banding. Anterior cruciate ligament is then plicated by pulling the autograft through the tibial and femoral tunnels under the control of arthroscopic technique. Thereafter, at constant traction behind the cortical fixation threads on the tibia, passive flexion cycles are performed and knee joint extension, autograft tension and final placement of femoral fixator and tibial fixator on frontal-inner surface of tibia are performed. Femoral tunnel is formed along the guide pin installed in the area of the stump of the anterior cruciate ligament by means of through drilling of the tunnel with a drill with diameter of 4.5 mm. Then, on the same spoke on the side of the joint, a countersound of the tunnel is made with a diameter corresponding to the diameter of the autograft to depth of 2 cm. Tibial tunnel is then formed with a cannulated drill of the diameter corresponding to the diameter of the autograft on a spoke using a tibial guide with an entry point above the tendon area of the goose-foot along the anterior-inner surface of the shin bone in the upper one-third, and an exit point in the center of the anterior cruciate ligament attachment area on the shin plateau. Between the above circular seams, in the proximal and distal portion of the graft, proximal and distal expansion zones are connected by means of proximal and distal corrugating threads, wherein length of said zones provides increase in their diameter when tightening corrugations of autograft by not less than 20 %. Ends of the threads of the distal corrugating suture, the proximal corrugating suture and the threads for cortical fixation on the tibia are pairwise threaded into the holes of the tibial fixator, made in the form of a two-stage plug, the first step of which with a cut inclined plane end face is made in the form of a hollow cylinder with a diameter not exceeding the diameter of the tibial tunnel. Coupled with first stage second stage has shape of disc protruding beyond said cylinder, wherein said disk has sectorial flat sections parallel to each other and lengthwise vertical plane passing through major axis of section of inclined section of cylinder. Within the volume of the adjacent cylinder on the disc there are four through holes, two of which are located in said longitudinal vertical plane with orientation on the mark on the disc in the direction of the cylinder cut, and two other through holes are located in the longitudinal horizontal plane passing through the small axis of the ellipse of the inclined section of the cylinder. On the side of the above cylinder on the protruding part of the disc there are sharpened pins, then the tibial retainer is gripped by the above clamps with a clamp and positioned by the orientation of the mark in the direction of the knee joint, tibial retainer is completely immersed by cylinder into tibial tunnel. In the holes of its disc in the longitudinal vertical plane, threads are passed for cortical fixation on the shin bone, corrugating threads of proximal and distal expansion parts are passed into holes in longitudinal horizontal plane of the disk. Thereafter, in the autograft constant tension by flexion in the knee joint by angle of 30° first tightens the cortical fixation on the shinbone, and then - the corrugating filaments of the proximal and distal reamer parts of the autograft. That is combined with insertion of the pointed spines into the bone. After that ends of threads are cut off, sutures and aseptic dressings are applied on wounds, and knee joint is immobilized with brace in position of extension.EFFECT: method provides the possibility of performing an inspection operation without preliminary bone grafting by maintaining the size of bone tunnels by avoiding the ingress of the articular fluid into the formed bone tunnels and uniform distribution of bending and axial microactions of grafts on walls of tunnels by means of stable cortical fixation of corrugating threads in a plane perpendicular to transplant bend surface.1 cl, 18 dwg, 1 ex