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1、Avulsion Fracture of Anterior Cruciate Ligament,Zhijie Xi,History,1875 Poncet 1970Avulsion fracture of the ACL was classified by Meyers MH 1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation 2008Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation t
2、echnique,Morbidity3/100000 14 of ACL injury Distribution of age children814 years old old womenover 40 years old,Accid E-merg Nurs，2004，12(3)：1 73-1 75 International Journal of Pediatrics, 2012, Article ID 932702, 6 pages,epidemiology,Fall injury and traffic accident51 Sports injuriesSkiing and foot
3、ball-14%,The Knee，2008，15(3)：164-167,Associated with capsule tear of meniscus or articular capsule, sometimes including medial and lateral collateral ligament injury or injury of articular cartilage,Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.,Relevant anatomical s
4、tructure,Resident ridge,Resident ridge,Branching ridge,Footprints,Footprints,The anterior medial bundle is tight in flexion the posterior lateral bundle is tight in the straight position,1,2,损伤机制,Young people - knee flexion, tibial internal rotation,Adults - hyperextension of the knee,ACL limits ant
5、erior displacement, hyperextension, and internal rotation,Diagnosis,Injury history of hyperextension of knee Bruise and hyphema The extension was limited Anterior drawer test and Lachman sign are positive X-ray and CT are conducive to understanding of fracture MRI is helpful to understand injury of
6、ACL, and others combined injury.,Anterior drawer test and Lachman sign,X-ray,CT,MRI,Meyers-McKeever classification,Arthroscopy 2005;211:86-92,How to identify fresh or old fractures in imaging,Treatment,I type - Conservative treatment to keep the knee in a functional position for 6 weeks and types -
7、Manipulation，if fail，selected surgery type - Surgery,Reduction,The drawer test after extension,P - R - I - C E program,Protection Rest Ice Compression Elevate,It used to be the most commonly treatment program to open reduction and fixed with wire,A failed case,Case 1,Single tunnel fixation with stee
8、l wire and extrusion screw,No extrusion nail was found before operation,impinge,If the fracture mass is small, using Ethibond suture,Old fracture of avulsion fracture of ACL,Case 2,Wound freshness,To clean and remove all dead, damaged tissue around of the fracture mass,To introduce the wire by a lum
9、bar puncture needle,To thread through No. 5 Ethibond, and fix fracture with “8“ tension band,To inspect carefully,The patients were followed up for 1 month after surgery,Case 3,To use PDSii as the thread,To use PDSii as the thread,To use PDSii as the thread,Case 4,Old avulsion fracture of ACL,With b
10、one sclerosis, and ACL stretch and tear,The bone block cannot be removed with the nucleus pulposus clamp,micro-grinding drill to drill,To remove bone mass with nucleus pulposus forceps,Enlargement of the condylar fossa,The picture was taken after reconstruction of anterior cruciate ligament,Postoper
11、ative X-ray,followed up for 1 month after surgery,For a bigger fracture block, hollow screw is a good choice,Lateral meniscus (LM) is being pulled and displaced,If the fracture of the tibial plateau is combined, first of all, the fracture should be fixed,X-ray showed ACL avulsion fracture combined w
12、ith tibial plateau fracture,Case 4,MRI,To check the stability of knee joint before operation,To carefully examine the collapse of the lateral tibial plateau To reduce and fix tibial plateau fractures,To remove the synovial tissue of the femoral condyle,Arthroscopic image of the reduce fracture,To cu
13、t the transverse ligament of meniscus,The reduction of the fracture mass is blocked by the transverse ligament of the meniscus,To reduce fracture,To fixed fracture with k-wire temporarily,To drill into second K-wire,A guide pin is inserted,To screw into the hollow screw,To inspect after fixation,Postoperative X-ray,Postoperative functional rehabilitation,To take positive exercise of knee flexion and extension in 2 to 4 weeks To load limitedly within 9 weeks physical exercise can be take 12 weeks later,Thanks for your attention,