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1、History,1875 Poncet1970Avulsion fracture of the ACL was classified by Meyers MH1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation2008Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique,Morbidity3/10000014 of ACL injuryDistribution of age
2、 children814 years old old womenover 40 years old,Accid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics,2012,Article ID 932702,6 pages,epidemiology,Fall injury and traffic accident51Sports injuriesSkiing and football-14%,The Knee，2008，15(3)：164-167,Associated with capsule tear of
3、 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 structure,Resident ridge,Resident ridge,Branching ridge,Footprints,Footp
4、rints,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 anterior displacement,hyperextension,and internal rotation,Diagnosis,Injury his
5、tory of hyperextension of kneeBruise and hyphemaThe extension was limitedAnterior drawer test and Lachman sign are positiveX-ray and CT are conducive to understanding of fracture MRI is helpful to understand injury of ACL,and others combined injury.,Anterior drawer test and Lachman sign,X-ray,CT,MRI
6、,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-Manipulation，if fail，selected surgery type-Surgery,Reduction,The drawer test after exte
7、nsion,P-R-I-C E program,ProtectionRestIceCompressionElevate,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 steel wire and extrusion screw,No extrusion nailwas found beforeoperation,impinge,If the fracture mass
8、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 lumbar puncture needle,To thread through No.5 Ethibond,and fix fracture with 8 tension band,To inspect car
9、efully,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 bone sclerosis,and ACL stretch and tear,The bone block cannot be removed with the nucleus pulposus clamp,mic
10、ro-grinding drillto drill,To remove bone masswith nucleus pulposus forceps,Enlargement of the condylar fossa,The picture was taken after reconstruction of anterior cruciate ligament,Postoperative X-ray,followed up for 1 month after surgery,For a bigger fracture block,hollow screw is a good choice,La
11、teral 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 with tibial plateau fracture,Case 4,MRI,To check the stability of knee joint before operation,To carefully examine t
12、he collapse of the lateral tibial plateauTo reduce and fix tibial plateau fractures,To remove the synovial tissue of the femoral condyle,Arthroscopic image of the reduce fracture,To cut the transverse ligament of meniscus,The reduction of the fracture mass is blockedby the transverse ligament of the
13、 meniscus,To reduce fracture,To fixed fracture with k-wire temporarily,To drill into secondK-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 weeksphysical exercise can be take 12 weeks later,Thanks for your attention,
