tailieunhanh - Chondral Disease of the Knee - part 7

Phục hồi chức năng sau phẫu thuật đã được hướng dẫn chủ yếu bởi giao thức ACL trừ hạn chế mang trọng lượng vượt quá 90 độ uốn đầu gối trong 6 tuần đầu tiên. Quay trở lại hoạt động không hạn chế được phép vào 6 tháng tuổi. | Case 24 83 Figure . Posteroanterior 45-degree flexion weight-bearing A and lateral B radiograph obtained 14 months after allograft medial meniscus transplantation and revision ACL reconstruction. mattress sutures and seating of the posterior bone plug into its recipient tunnel. The anterior horn was fixed into a blind tunnel at the anatomic insertion of the native meniscus insertion site. Finally the ACL was passed and secured with a staple on the tibia and a ligament button on the femur due to slight graft mismatch and partial compromise of the posterior cortex of the femur Figure E . Postoperative rehabilitation was guided primarily by the ACL protocol except for restriction of weight bearing beyond 90 degrees of knee flexion for the first 6 weeks. Return to unrestricted activities was permitted at 6 months. FOLLOW-UP At 18 months the patient had full range of motion denied any medial-sided knee pain and had no complaints of instability. He had a grade I Lachman examination with a firm endpoint and a negligible pivot shift. Radiographs demonstrated excellent positioning of the ACL graft and proper se of fce meỳcus rrans-. structecI ACL of continued risk for prema- pie t bone plugs .1 This ls trial version narrowing was present Figure . Repeat KT-2000 evaluation revealed a 2-mm side-to-side difference on maximum manual testing. The patient recently returned to participating in competitive soccer. DECISION-MAKING FACTORS 1. Young high-demand patient with ipsilateral symptoms related to a prior subtotal meniscectomy with a chief complaint of pain and instability. 2. Loss of the primary ACL and secondary posterior horn of the medial meniscus restraints to anterior translation of the left knee. 3. Intact articular cartilage. 4. A relative contraindication to performing an isolated medial meniscus transplant without ACL reconstruction. Similarly revision ACL reconstruction without improving the secondary restraints for anterior tibial translation may

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