Treatment of patients with knee cartilage injury combined with lesions of the anterior crucial ligament and meniscus
Keywords:arthroscopy, knee joint, articular cartilage, meniscus, anterior cruciate ligament, chondromalacia
Purpose: to study the possibility to use rational arthroscopic tactics of treatment and duration of rehabilitation of patients with injured knee cartilage combined with the anterior cruciate ligament (ACL) and menisci lesions on the basis of retrospective analysis of 735 knee joint surgeries with using of arthroscopic methods.
Methods: combined injury of the joint cartilage of different severity was diagnosed in 519 patients (71.7 %), primary ACL lesion was observed in 221 patients. Meniscectomy was performed in 514 patients. In 106 patients with menisci and ACL lesions posttraumatic changes in joint cartilage of different severity according to Outerbridge were detected. In accordance with this patients were categorised into 4 groups. The 5th group (control) contains patients with ACL and meniscus lesions without any changes in joint cartilage. Patients with menisci lesions in 97% of cases underwent partial resection of the injured part, and just in 3% (cases of paracapsular injuries) meniscus suturing was performed. In 91% patients meniscus posterior horn lesions were revealed, in 6% - injuries of the meniscus body, and just in 3% of all meniscus lesions anterior horn of meniscus was injured.
Results: for restoration of ACL injured were used tendons of semitendinous and gracilis muscles. In postoperative period we recommended offloading of the operated lower extremity depend on changes in joint cartilage but not longer than 6 months after surgery. Thus in case of changes in cartilage of the first grade no other manipulations on cartilage except restoration of intraarticular structures were performed. In cases of changes in cartilage of the second and third grades we performed vaporization of its injured parts, in cases of the fourth grade osteoperforation of the defected segments was done.Conclusions: it was confirmed that arthroscopy is the «gold standard» in diagnostics and treatment of injured structures of knee joint enabling visualisation of the degree and depth of joint cartilage changes, determining of indications for appropriate treatment, performing of medicinal manipulations, planning adequate comprehensive postoperative therapy and rehabilitation. Intraoperative tactics of treatment of patients with combined ACL, meniscus and joint cartilage lesion depends on severity of cartilage changes. Duration of postoperative rehabilitation increased with the growth of severity of joint cartilage changes. Therefore, combination of arthroscopic treatment of injured joint cartilage injury of ІІІ-ІV grades and proper rehabilitation in young patients now remains the most relevant and requires further study and improvement.
Bolhovitin P. V. Recovery cruciate ligament surgery in system instability of the knee joint: dis. ... candidate medical sciences: 14.01.21 / Bolhovitin Pavel. — H., 2005. — 168 p.
Girshina S. G. Stifle (injuries and pain syndromes) / S. Girshina, G. Lazishvili. — M.: NTSSSH Bakulev RAMS, 2007. — 352 p.
Grebenuk Yu. A. Treatment of chronic anteromedial instability of the knee: dis. ... candidate medical sciences: 14.01.21 / Grebenuk Yuriy Aleksandrovich. — D., 1999. — 144 p.
Eysmont O. L. Arthroscopic diagnosis and treatment of local cartilage lesions of the knee / O. L. Eysmont, A. V. Borisov, B. V. Maljuk // Orthopedics, Traumatology and Prosthetics. — 2007. — № 3. — P. 111-116.
Angermann P. Arthroscopic chondrectomy as a treatment of cartilage lesions / P. Angermann, K. Harager, L. L. Tobin // Knee Surg. Sports. Traumatol. Arthrosc. — 2002. — Vol. 10 (1). — P. 6–9.
Articular cartilage lesions in 993 consecutive knee arthroscopies / A. Aroen, S. Loken, S. Heir [et al.] // Am. J. Sports Med. 2004. — Vol. 32 (1). — P. 211–215.
International Cartilage Repair Society ICRS. [Електронний ресурс] / M. Brittberg, P. Aglietti, R. Gambardella [et al.] // ICRS. — 2005. — Режим доступа: http://www.catilage.org.
International Cartilage Repair Society ICRS. [Електронний ресурс] / M. Brittberg, P. Aglietti, R. Gambardella [et al.] // ICRS. — 2005. — Режим доступа: http://www.orthopaedicscore.com.
Jackson D. W. The anterior cruciate ligament / D. W. Jackson // Raven press, New York, 1993. — 453 p.
Krishnan and Randle. ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis / Krishnan and Randle // J. Orthop. Surg. Res. — 2009. — Vol. 4. — 43 р.
Outerbridge R. E. The etiology of chondromalacia patellae / R. E. Outerbridge // J. Bone Joint Surg. — 1961. — Vol. 43-B. — Р. 752–757.
Strobel M. J. Vorderes Kreusband / M. J. Strobel, T. Zantop // Endo, Press, 2008. — 259 p.
Shelbourne K. D. Outcome of Untreated Traumatic Articular Cartilage Defects of the Knee. A Natural History Study / K. D. Shelbourne, S. Jari, T. Gray // J. Bone Joint Surg. — 2003. — Vol. 85-A. — Р. 8–16.
Tegner Y. Rating systems in the evaluation of knee ligament injuries / Y. Tegner, J. Lysholm // Clin. Ortop. — 1985. — Vol. 198. — P. 43–49.
Surgical treatment of anterior cruciate ligament injuries in adolescents using double-looped semitendinosis and gracilis tendons: supraepiphysary femoral and tibial fixation / P. Volpi, M. Galli, C. Bait [et al.] // Arthroscopy. — 2004. — Vol. 20 (4). — P. 447–449.
Copyright (c) 2014 Sergey Strafun, Oleg Kostogryz
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available after 6 months from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).