JBJS essential surgical techniques · 2016
Surgical Technique for Arthroscopic Lateral Collateral Ligament Repair.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Kim Jeong Woo, Lee Sung Hyun, Kim Se Jin, Park Jin Sung
Аннотация
INTRODUCTION: Arthroscopic repair of the lateral collateral ligament (LCL) complex in patients who have posterolateral rotatory instability after an unstable elbow dislocation, with or without an intra-articular fracture, is an alternative treatment for restoring stability of the elbow and obtaining successful clinical and radiographic results.
STEP 1 COMPUTED TOMOGRAPHY CT MAGNETIC RESONANCE IMAGING MRI AND PREOPERATIVE PLANNING: Obtain radiographs and CT and MRI scans to make an accurate analysis of the fracture patterns and develop an understanding of soft-tissue comorbidities.
STEP 2 POSITION THE PATIENT AND PLACE THE PORTALS: Place the patient in the lateral decubitus position and create proximal anteromedial, proximal anterolateral, anterolateral, and radial head portals as working portals and a posterior soft-spot portal as a viewing portal for the repair of the LCL complex.
STEP 3 DIAGNOSTIC ARTHROSCOPY: Identify concomitant radial head and coronoid fractures, and confirm the LCL-complex tear intraoperatively.
STEP 4 MANAGEMENT OF CONCOMITANT INJURIES: Treat intra-articular fractures arthroscopically before the LCL-complex repair.
STEP 5 ARTHROSCOPIC LCL-COMPLEX REPAIR VIDEO 1: After soft-tissue debridement using the soft-spot portal as a viewing portal and the proximal anterolateral portal as a working portal, decorticate the footprint of the humeral attachment of the LCL complex with use of a shaver or burr and then make a modified Mason-Allen stitch using a needle, fixing the suture with a knotless anchor, to achieve a stable elbow joint.
STEP 6 POSTOPERATIVE MANAGEMENT: After postoperative immobilization of the elbow for 2 to 3 days, instruct the patient to perform passive exercises, returning to a full range of motion at 4 to 6 weeks after surgery, and typically returning to full activity at 3 months after the operation.
RESULTS: To date, arthroscopic LCL-complex repair has produced excellent results, with all 13 patients in our original study reporting complete resolution of the elbow instability and demonstrating a negative result on the lateral pivot-shift test15.
STEP 1 COMPUTED TOMOGRAPHY CT MAGNETIC RESONANCE IMAGING MRI AND PREOPERATIVE PLANNING: Obtain radiographs and CT and MRI scans to make an accurate analysis of the fracture patterns and develop an understanding of soft-tissue comorbidities.
STEP 2 POSITION THE PATIENT AND PLACE THE PORTALS: Place the patient in the lateral decubitus position and create proximal anteromedial, proximal anterolateral, anterolateral, and radial head portals as working portals and a posterior soft-spot portal as a viewing portal for the repair of the LCL complex.
STEP 3 DIAGNOSTIC ARTHROSCOPY: Identify concomitant radial head and coronoid fractures, and confirm the LCL-complex tear intraoperatively.
STEP 4 MANAGEMENT OF CONCOMITANT INJURIES: Treat intra-articular fractures arthroscopically before the LCL-complex repair.
STEP 5 ARTHROSCOPIC LCL-COMPLEX REPAIR VIDEO 1: After soft-tissue debridement using the soft-spot portal as a viewing portal and the proximal anterolateral portal as a working portal, decorticate the footprint of the humeral attachment of the LCL complex with use of a shaver or burr and then make a modified Mason-Allen stitch using a needle, fixing the suture with a knotless anchor, to achieve a stable elbow joint.
STEP 6 POSTOPERATIVE MANAGEMENT: After postoperative immobilization of the elbow for 2 to 3 days, instruct the patient to perform passive exercises, returning to a full range of motion at 4 to 6 weeks after surgery, and typically returning to full activity at 3 months after the operation.
RESULTS: To date, arthroscopic LCL-complex repair has produced excellent results, with all 13 patients in our original study reporting complete resolution of the elbow instability and demonstrating a negative result on the lateral pivot-shift test15.