as PDF - Çankaya Ortopedi

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ÇANKAYA ORTHOPEDICS
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Treatment of chronic collateral
injuries
Prof. N. Reha Tandogan, M.D
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Ortoklinik / Çankaya Orthopaedics, Ankara
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Dr. Asım Kayaalp
Dr. Mahmut Kış
Dr. Uğur Gönç
Dr. Uğur Şaylı
Dr. Mazhar Tokgözoğlu
Dr. Muharrem Yazıcı
Dr. N. Reha Tandoğan
Dr. Mümtaz Alpaslan
Dr. Kürşat Teker
Dr. Altuğ Tanrıöver
Dr. Gürkan Erkula
Dr. Bülent Atilla
Phys. İpek İkiz
31y, M
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 Motor vechicle accident 1 year ago
 Lateral tibial plateau fracture fixed with
screws
 Concomittant lateral meniscectomy
 Chief complaint instability and inability to run
 Pain, crepitus and effusion
Dr. N. Reha Tandoğan
Valgus stress testing
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
Antero-posterior laxity
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
Zorlamalı grafiler
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
Patello-femoral joint
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
Coronal sections
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
Cruciates
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O
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
Menisci
medial
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O
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ÇANKAYA ORTHOPEDICS
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lateral
Dr. N. Reha Tandoğan
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ÇANKAYA ORTHOPEDICS
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1. Anatomical single
bundle ACL
reconsrtruction using
ST-G grafts from the
same knee
Dr. N. Reha Tandoğan
2. Contra-lateral ST graft
for MPFL reconstrucion
3. Contra-lateral gracilis
graft for superficial MCL
and posterior oblique
ligament reconstruction
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
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ÇANKAYA ORTHOPEDICS
Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
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 Untreated or missed
injuries
 Residual laxity after
conservative treatment
 Residual laxity after
previous surgery
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Chronic medial injuries
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 Graft sources ?
 Hardware ?
 Tunnels ?
Dr. N. Reha Tandoğan
Stress X-rays
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ÇANKAYA ORTHOPEDICS
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 Objective quantification of
laxity
 Post-op evaluation of results
Dr. N. Reha Tandoğan
Surgical principles
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ÇANKAYA ORTHOPEDICS
 Verify extremity alignment
 Femoral osteotomy for valgus knees ?
 sMCL
 POL
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 Reconstruct cruciates
 Reconstruct medial side
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 Cartilage & meniscal regeneration/
replacement
Dr. N. Reha Tandoğan
Historical procedures
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ÇANKAYA ORTHOPEDICS
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 Robust but lax MCL
 Changes isometry
O
 Pesplasty
 Capsular plication
 Bone block advancement
Dr. N. Reha Tandoğan
Options for reconstruction
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ÇANKAYA ORTHOPEDICS
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 Reconstruction of
sMCL only
Dr. N. Reha Tandoğan
Isolated SMCL reconstruction
O
ka
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 Usually combined with
plication/advancement
of PMC
 % 83 success, 2mm(-)
valgus in stress X-rays
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ÇANKAYA ORTHOPEDICS
 Yoshiya S. Am. J. Sports Med.
2005; 33; 1380
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 Does not address laxity
of POL in full extension
Dr. N. Reha Tandoğan
Single femoral tunnel sMCL
and POL reconstruction
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ÇANKAYA ORTHOPEDICS
 Less than 2 mm medial opening
22/24 patients
 Kim SJ. J Bone Joint Surg Br. 2008; 90(10):13237.
O
 % 98 IKDC A or B in 61 patients
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 Lind M. J Bone Joint Surg Br. 2008;90(10):13237.
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 Early failure under cyclic loading
in cadaver testing
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 LaPrade RF. Clin Orthop Relat Res (2012)
470:806–814
Dr. N. Reha Tandoğan
Lind M, 2008
ÇANKAYA ORTHOPEDICS
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Anatomical reconstruction
of sMCL, dMCL& POL
 2 seperate grafts, 4 tunnels
in anatomical insertions
ka
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 IKDC score 76
 Valgus opening 1.3 mm
O
 28 patients, 6mo-3yrs f-up
C
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• LaPrade RF. Clin Orthop Relat Res
(2012) 470:806–814
Dr. N. Reha Tandoğan
Coobs BR,
AJSM 2009
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O
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ÇANKAYA ORTHOPEDICS
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www.ortoklinik.com
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Dr. N. Reha Tandoğan