as PDF - Çankaya Ortopedi
Transkript
as PDF - Çankaya Ortopedi
rto pe di ÇANKAYA ORTHOPEDICS ka ya O Treatment of chronic collateral injuries Prof. N. Reha Tandogan, M.D an Ortoklinik / Çankaya Orthopaedics, Ankara C 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 rto pe di ÇANKAYA ORTHOPEDICS C an ka ya O 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 C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan Antero-posterior laxity C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan Zorlamalı grafiler C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan Patello-femoral joint C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan Coronal sections C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan Cruciates C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan Menisci medial ka ya O rto pe di ÇANKAYA ORTHOPEDICS C an lateral Dr. N. Reha Tandoğan rto pe di ÇANKAYA ORTHOPEDICS C an ka ya O 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 C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan C an ka ya O rto pe di ÇANKAYA ORTHOPEDICS Dr. N. Reha Tandoğan ÇANKAYA ORTHOPEDICS ka ya O Untreated or missed injuries Residual laxity after conservative treatment Residual laxity after previous surgery rto pe di Chronic medial injuries C an Graft sources ? Hardware ? Tunnels ? Dr. N. Reha Tandoğan Stress X-rays rto pe di ÇANKAYA ORTHOPEDICS C an ka ya O Objective quantification of laxity Post-op evaluation of results Dr. N. Reha Tandoğan Surgical principles rto pe di ÇANKAYA ORTHOPEDICS Verify extremity alignment Femoral osteotomy for valgus knees ? sMCL POL ka ya O Reconstruct cruciates Reconstruct medial side C an Cartilage & meniscal regeneration/ replacement Dr. N. Reha Tandoğan Historical procedures rto pe di ÇANKAYA ORTHOPEDICS C an ka ya Robust but lax MCL Changes isometry O Pesplasty Capsular plication Bone block advancement Dr. N. Reha Tandoğan Options for reconstruction rto pe di ÇANKAYA ORTHOPEDICS C an ka ya O Reconstruction of sMCL only Dr. N. Reha Tandoğan Isolated SMCL reconstruction O ka ya Usually combined with plication/advancement of PMC % 83 success, 2mm(-) valgus in stress X-rays rto pe di ÇANKAYA ORTHOPEDICS Yoshiya S. Am. J. Sports Med. 2005; 33; 1380 C an Does not address laxity of POL in full extension Dr. N. Reha Tandoğan Single femoral tunnel sMCL and POL reconstruction rto pe di 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 ka ya Lind M. J Bone Joint Surg Br. 2008;90(10):13237. an Early failure under cyclic loading in cadaver testing C LaPrade RF. Clin Orthop Relat Res (2012) 470:806–814 Dr. N. Reha Tandoğan Lind M, 2008 ÇANKAYA ORTHOPEDICS rto pe di Anatomical reconstruction of sMCL, dMCL& POL 2 seperate grafts, 4 tunnels in anatomical insertions ka ya IKDC score 76 Valgus opening 1.3 mm O 28 patients, 6mo-3yrs f-up C an • LaPrade RF. Clin Orthop Relat Res (2012) 470:806–814 Dr. N. Reha Tandoğan Coobs BR, AJSM 2009 ka ya O rto pe di ÇANKAYA ORTHOPEDICS TEŞEKKÜRLER C an www.ortoklinik.com www.cankayaortopedi.com Dr. N. Reha Tandoğan