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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >ACL rupture and posterior tibial slope - how do we handle this?
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ACL rupture and posterior tibial slope - how do we handle this?

机译：ACL破裂和后胫骨坡 - 我们如何处理这个？

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Aims and Objectives: In recent publications on acl-ruptures and especially on failure of acl reconstruction there comes a strong focus on posterior tibial slope (PTS). ACL reconstructions with a PTS of &12° have an 8 times higher risk of recurrent instability and reconstruction failure. But many questions stay unclear so far-When do we have to correct the tibial slope? How do we correct it? What about simultaneous frontal axis deviations? In this publication a new algorhythm is presented. Materials and Methods: The following aspects have to be evaluated Is the PTS the only dimension of the deformity or do we have to correct the frontal axis simultaneuosly? Performing a anterior closed wedge extension osteotomy: when do we go distal the tuberosity and when do we perform a tuberosity osteotomy and use it as “bio plating”? Osteosynthesis only screws or always plate? Are there indications for a contineous correction, f.e. with a hexapod? Whats the role of preoperative range of motion of the knee (especially extension)? Always tunnel filling in the same surgery? What about PCL insufficiency and low PTS? Results: An algorhythm is presented giving a treatment path for the different questions mentioned. The procedures are shown step by step in clinical examples and surgery documentation for every pathway. Conclusion: Posterior tibial slope plays an critical role in ACl recontruction. In primary ACl tear a slope correction is probably not indicated. In ACL reconstruction failure a analysis of the PTS needs to be done and correction needs to be discussed. Simultaneuous varus deormities need to be corrected by openwedge valgisation - extension high tibial osteotomy (HTO), while as isolated PTS elevation is subject to an anterior closed wedge extension HTO. Preoperative range of motion needs to be respected not to create hyperextension. Osteosynthesis can be perormed with only screws using the tibial tubercle as “bio-plating”. In cases of former bone-tendeon-bone (BTB) ACL reconstruction a tibial tubercle osteotomy should be avoided and a infratuberositeal osteotomy should be performed and stabilized with plate osteosynthesis. In severe postraumatic cases contineous correction of the slope with fixateur externe, f.e. hexapodes, needs to be performed.
机译：目标与目标：在最近对ACL破裂的出版物，特别是关于ACL重建的失败，在后部胫骨斜率（PTS）上具有强烈的重点。具有＆gt的PTS的ACL重建; 12°具有较高的经常性不稳定和重建失败的风险较高的8倍。但许多问题仍然不清楚到目前为止 - 我们什么时候必须纠正胫骨斜坡？我们如何纠正它？同时朝南偏差怎么样？在本出版物中，提出了新的almorythm。材料和方法：必须评估以下几个方面是PTS唯一的畸形尺寸，或者我们必须同时校正前轴吗？执行前闭楔延伸截骨术：何时去远端结节，我们什么时候进行结节骨质切断，用它作为“生物电镀”？ Osteosynthesis仅螺钉或始终板？是否存在有关纠正的迹象，F.E.用六角形？什么是术前范围的膝盖运动范围的作用（特别是延伸）？总是隧道填充相同的手术？ PCL不足和低分离行程怎么样？结果：提出了一种抗嗜族，给出了所提到的不同问题的治疗路径。该程序在每个途径的临床实例和手术文件中逐步显示。结论：后胫骨坡在ACL重新吻中发挥着关键作用。在主ACL中，可能未指示斜率校正。在ACL重建故障中，需要完成对PTS的分析，需要讨论校正。同时性别的差异需要通过露营术算子 - 延伸高胫骨截骨术（HTO）来校正，而当隔离的PTS升降处于前闭楔延伸HTO的情况下。需要遵守术前运动范围，不要创造过伸流。骨质合成可以用仅使用胫骨结节的螺钉作为“生物电镀”来造水。在前骨卷曲骨（BTB）ACL重建的情况下，应避免胫骨结节骨质术，并且应用板骨合成进行胰抗胰酸碱骨质图术和稳定。在严重的儿退外壳中，斜坡与Fixateur外部的倾斜矫正需要执行六探测器。

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