Bài báo đồng thuận của Nhóm Chuyên gia về Dây chằng trước bên trong về quản lý sự xoay bên trong và mất ổn định của khớp gối thiếu dây chằng chéo trước

Journal of Orthopaedics and Traumatology - Tập 18 - Trang 91-106 - 2017
Bertrand Sonnery-Cottet1, Matthew Daggett2, Jean-Marie Fayard1, Andrea Ferretti3, Camilo Partezani Helito4, Martin Lind5, Edoardo Monaco3, Vitor Barion Castro de Pádua6, Mathieu Thaunat1, Adrian Wilson7, Stefano Zaffagnini8, Jacco Zijl9, Steven Claes10
1Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
2Kansas City University, Kansas City, USA
3Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
4Knee Surgery Division, University of São Paulo, São Paulo, Brazil
5Division of Sportstraumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus C, Denmark
6Associação Beneficente Hospital Universitário de Marilia-SP Brazil, Cidade Universitária, Marilia, Brazil
7Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, UK
8Dipartimento Rizzoli Sicilia, Ortopedia e Traumatologia, Università di Bologna, Bagheria, Italy
9St. Antonius Hospital, Utrecht, The Netherlands
10Department of Orthopaedic Surgery and Traumatology, AZ Herentals, Herentals, Belgium

Tóm tắt

Mục đích của bài báo này là cung cấp cái nhìn tổng quan về những nghiên cứu mới nhất về dây chằng bên trước (ALL) và trình bày sự đồng thuận của Nhóm Chuyên gia về ALL về giải phẫu, các dấu hiệu hình ảnh, cơ sinh học, chẩn đoán lâm sàng và hình ảnh, phân loại tổn thương, kỹ thuật phẫu thuật và kết quả lâm sàng. Một sự đồng thuận về các chủ đề gây tranh cãi liên quan đến ALL và sự bất ổn định ở bên trong đầu gối đã được thiết lập dựa trên ý kiến của các chuyên gia, những công bố mới nhất về chủ đề này và sự trao đổi kinh nghiệm trong cuộc họp ALL Experts Meeting (tháng 11 năm 2015, Lyon, Pháp). ALL nằm sâu bên dưới dải iliotibial. Nguồn gốc xương đùi chỉ nằm phía sau và trên của mỏm lồi cầu bên; điểm bám vào xương chày cách mỏm Gerdy 21,6 mm về phía sau và 4-10 mm dưới đường khớp xương chầy. Ở chế độ hình ảnh bên cạnh, nguồn gốc xương đùi nằm trong phần tứ giác hạ sau và điểm bám vào xương chày gần với trung tâm của mặt phẳng xương chày gần. Isometry thuận lợi của một sự tái tạo ALL được thấy khi vị trí xương đùi ở gần hơn và ở phía sau mỏm lồi cầu bên, với ALL căng khi duỗi và lỏng khi gập. ALL có thể được nhìn thấy qua siêu âm, hoặc trên các hình ảnh MRI phẳng T2 có trọng số với đánh giá loại bỏ mỡ proton. Chấn thương ALL liên quan đến gãy xương Segond và thường xảy ra cùng với chấn thương dây chằng chéo trước (ACL) cấp tính. Nhận diện và sửa chữa các tổn thương ALL nên được xem xét để cải thiện khả năng kiểm soát sự ổn định xoay mà ACL tái tạo cung cấp. Đối với những bệnh nhân có nguy cơ cao, sự tái tạo kết hợp giữa ACL và ALL cải thiện khả năng kiểm soát xoay và giảm tỷ lệ tái phát mà không làm tăng tỷ lệ biến chứng hậu phẫu so với tái tạo chỉ có ACL. Kết luận, bài báo này cung cấp một sự đồng thuận hiện đại về tất cả các đặc điểm đã được nghiên cứu của ALL. Những phát hiện này yêu cầu nghiên cứu trong tương lai để tiếp tục kiểm nghiệm những quan sát ban đầu này, với mục tiêu cuối cùng là cải thiện kết quả lâu dài cho các bệnh nhân bị chấn thương ACL.

Từ khóa

#dây chằng trước bên #sự bất ổn định khớp gối #tái tạo dây chằng chéo trước

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Journal of Orthopaedics and Traumatology

Tập 18

91-106

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