1、Avulsion Fracture of Anterior Cruciate Ligament Zhijie Xi 關節鏡下治療前叉止點撕脫性骨折1Avulsion Fracture of AnteriorHistory1875 Poncet1970Avulsion fracture of the ACL was classified by Meyers MH1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation2008Jinzhong Zhao reported a

2、rthroscopic Figure-of-8 suture fixation technique 關節鏡下治療前叉止點撕脫性骨折2History1875 Poncet關節鏡下治療前叉止點Morbidity3/10000014 of ACL injuryDistribution of age children814 years old old womenover 40 years oldAccid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics, 2012, Article ID 932702, 6 pag

3、es epidemiology關節鏡下治療前叉止點撕脫性骨折3Morbidity3/100000Accid E-merFall injury and traffic accident51Sports injuriesSkiing and football-14%The Knee，2008，15(3)：164-167關節鏡下治療前叉止點撕脫性骨折4Fall injury and traffic accideAssociated with capsule tear of meniscus or articular capsule, sometimes including medial and la

4、teral collateral ligament injury or injury of articular cartilageArthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.關節鏡下治療前叉止點撕脫性骨折5Associated with capsule tear oRelevant anatomical structure關節鏡下治療前叉止點撕脫性骨折6Relevant anatomical structure關Resident ridge關節鏡下治療前叉止點撕脫性骨折7Resid

5、ent ridge關節鏡下治療前叉止點撕脫性骨折7Resident ridge關節鏡下治療前叉止點撕脫性骨折8Resident ridge關節鏡下治療前叉止點撕脫性骨折8Branching ridge關節鏡下治療前叉止點撕脫性骨折9Branching ridge關節鏡下治療前叉止點撕脫性骨折Footprints關節鏡下治療前叉止點撕脫性骨折10Footprints關節鏡下治療前叉止點撕脫性骨折10Footprints關節鏡下治療前叉止點撕脫性骨折11Footprints關節鏡下治療前叉止點撕脫性骨折11關節鏡下治療前叉止點撕脫性骨折12關節鏡下治療前叉止點撕脫性骨折12The anterior

6、 medial bundle is tight in flexion the posterior lateral bundle is tight in the straight position關節鏡下治療前叉止點撕脫性骨折13The anterior medial bundle is 12損傷機制Young people - knee flexion, tibial internal rotationAdults - hyperextension of the kneeACL limits anterior displacement, hyperextension, and internal

7、 rotation關節鏡下治療前叉止點撕脫性骨折1412損傷機制Young people - knee flexDiagnosisInjury history 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, an

8、d others combined injury.關節鏡下治療前叉止點撕脫性骨折15DiagnosisInjury history of hypAnterior drawer test and Lachman sign 關節鏡下治療前叉止點撕脫性骨折16Anterior drawer test and LachmX-ray關節鏡下治療前叉止點撕脫性骨折17X-ray關節鏡下治療前叉止點撕脫性骨折17CT關節鏡下治療前叉止點撕脫性骨折18CT關節鏡下治療前叉止點撕脫性骨折18MRI關節鏡下治療前叉止點撕脫性骨折19MRI關節鏡下治療前叉止點撕脫性骨折19Meyers-McKeever class

9、ificationArthroscopy 2005;211:86-92關節鏡下治療前叉止點撕脫性骨折20Meyers-McKeever classificatioHow to identify fresh or old fractures in imaging關節鏡下治療前叉止點撕脫性骨折21How to identify fresh or old fTreatmentI type Conservative treatment to keep the knee in a functional position for 6 weeks and types Manipulation，if fail

10、，selected surgery type Surgery關節鏡下治療前叉止點撕脫性骨折22TreatmentI type ConservatiReduction The drawer test after extension關節鏡下治療前叉止點撕脫性骨折23Reduction The drawer test afteP - R - I - C E program ProtectionRestIceCompressionElevate關節鏡下治療前叉止點撕脫性骨折24P - R - I - C E program ProtIt used to be the most commonly tre

11、atment program to open reduction and fixed with wire關節鏡下治療前叉止點撕脫性骨折25It used to be the most commonlA failed caseCase 1關節鏡下治療前叉止點撕脫性骨折26A failed caseCase 1關節鏡下治療前叉止點撕Single tunnel fixation with steel wire and extrusion screw關節鏡下治療前叉止點撕脫性骨折27Single tunnel fixation with stNo extrusion nailwas found bef

12、oreoperationimpinge關節鏡下治療前叉止點撕脫性骨折28No extrusion nailimpinge關節鏡下治療If the fracture mass is small, using Ethibond suture 關節鏡下治療前叉止點撕脫性骨折29If the fracture mass is small,Old fracture of avulsion fracture of ACLCase 2關節鏡下治療前叉止點撕脫性骨折30Old fracture of avulsion fractWound freshness關節鏡下治療前叉止點撕脫性骨折31Wound fre

13、shness關節鏡下治療前叉止點撕脫性骨折To clean and remove all dead, damaged tissue around of the fracture mass關節鏡下治療前叉止點撕脫性骨折32To clean and remove all dead, To introduce the wire by a lumbar puncture needle 關節鏡下治療前叉止點撕脫性骨折33To introduce the wire by a lumTo thread through No. 5 Ethibond, and fix fracture with 8 tensi

14、on band 關節鏡下治療前叉止點撕脫性骨折34To thread through No. 5 EthiboTo inspect carefully關節鏡下治療前叉止點撕脫性骨折35To inspect carefully關節鏡下治療前叉止點The patients were followed up for 1 month after surgery關節鏡下治療前叉止點撕脫性骨折36The patients were followed up Case 3To use PDSii as the thread關節鏡下治療前叉止點撕脫性骨折37Case 3To use PDSii as the t

15、hreTo use PDSii as the thread關節鏡下治療前叉止點撕脫性骨折38To use PDSii as the thread關節鏡下To use PDSii as the thread關節鏡下治療前叉止點撕脫性骨折39To use PDSii as the thread關節鏡下Case 4Old avulsion fracture of ACL關節鏡下治療前叉止點撕脫性骨折40Case 4Old avulsion fracture ofWith bone sclerosis, and ACL stretch and tear關節鏡下治療前叉止點撕脫性骨折41With bon

16、e sclerosis, and ACL sThe bone block cannot be removed with the nucleus pulposus clampmicro-grinding drillto drill 關節鏡下治療前叉止點撕脫性骨折42The bone block micro-grinding To remove bone masswith nucleus pulposus forcepsEnlargement of the condylar fossa關節鏡下治療前叉止點撕脫性骨折43To remove bone massEnlargementThe pictur

17、e was taken after reconstruction of anterior cruciate ligament關節鏡下治療前叉止點撕脫性骨折44The picture was taken after rePostoperative X-ray關節鏡下治療前叉止點撕脫性骨折45Postoperative X-ray關節鏡下治療前叉止點撕followed up for 1 month after surgery關節鏡下治療前叉止點撕脫性骨折46followed up for 1 month after For a bigger fracture block, hollow screw

18、 is a good choice關節鏡下治療前叉止點撕脫性骨折47For a bigger fracture block, hLateral meniscus (LM) is being pulled and displaced關節鏡下治療前叉止點撕脫性骨折48Lateral meniscus (LM) is beingIf the fracture of the tibial plateau is combined, first of all, the fracture should be fixed關節鏡下治療前叉止點撕脫性骨折49If the fracture of the tibia

19、l X-ray showed ACL avulsion fracture combined with tibial plateau fractureCase 4關節鏡下治療前叉止點撕脫性骨折50X-ray showed ACL avulsion fracMRI關節鏡下治療前叉止點撕脫性骨折51MRI關節鏡下治療前叉止點撕脫性骨折51To check the stability of knee joint before operation關節鏡下治療前叉止點撕脫性骨折52To check the stability of kneeTo carefully examine the collapse

20、 of the lateral tibial plateauTo reduce and fix tibial plateau fractures關節鏡下治療前叉止點撕脫性骨折53To carefully examine the collaTo remove the synovial tissue of the femoral condyleArthroscopic image of the reduce fracture關節鏡下治療前叉止點撕脫性骨折54To remove the synovial tissue To cut the transverse ligament of meniscus The reduction of the fracture mass is blockedby the transverse ligament of the meniscus 關節鏡下治療前叉止點撕脫性骨折55To cut the transverse ligame