运动医学未翻

ARARECASEOFINTRA-ARTICULARDISPLACEMENTOFENDOBUTTONFOLLOWINGACLRECONSTRUCTIONHOWLSean1LEEKengThiam1

1DepartmentofOrthopaedicSurgery,TanTockSengHospital,SingaporeINTRODUCTIONAnteriorcruciateligament(ACL)injuryisincreasinglycommonintheactiveindividualEndoButtonwithcontinuousloopisapopularchoiceoffemoralcorticalsuspensoryfixationBiomechanicallystrongerthaninterferencescrewsReliableclinicalesINTRODUCTION

ComplicationsComplicationsfromitsusageremainrareTheseincludesofttissueinterposition,pletepassageoftheEndobuttonaswellasraredisplacementintothekneejoint.WepresentararecaseofEndobuttondisplacementinthekneejointafterloopruptureCASEREPORT24yearmaleLeftACLrupture3yearsagoSinglebundleACLRusing9mmhamstringautograftSeenatourinstitutionwithsuddenpainandswellingwhilstattemptingtostandupfromaseatedpositionPositiveLachmanandAnteriordrawertestX-RAYSAFTERINITIALACLRX-RAYSATPRESENTATIONARTHROSCOPICFINDINGSIntra-articularEndoButtonfoundwedgedposteriortolateralfemoralcondyle(*)Femoraltunnelnotedtoexitwithinthesuprapatellarpouchwithruptureofcontinuousloopofendobutton*DISCUSSIONIntra-articularplacementoftheEndoButtonmaypre-disposetoearlyfailureSynovialfluidinfiltrationintofemoralbonetunnelmayresultinpoortendon-bonehealing/graftincorporationIflocatedinthepatellofemoralregion,maybepredisposedtoshearingandimpingementInaddition,anteriorplacementresultsinincreasedstressesontheACLgraftDISCUSSIONManyACLRsurgeriesareperformedbygeneralorthopaedicsurgeonswhoperform<10casesperyear.Wemendthatlow-volumesurgeonswithlimitedexperience:Performascreeningarthroscopyofthesuprapatellarpouchandlateralgutterafterthefemoraltunnelisreamedandpullingsutureispassed,orwhentheEndoButtonisflipped,beforetibialfixationEnsurethatEndoButtondoesnotlieintra-articularlyDISCUSSIONRemovalofEndoButtoncanbechallengingPositionmaymigratefromoriginalX-rayInourpatientitbecamewedgedbetweenposteriortibialplateauandcapsule,andhastoberetrievedviaposteromedialandposterolateralportals,whichmaybetechnicallychallengingIntra-operativeI.I.criticalifEndobuttoncannotbelocatedviastandardarthroscopyCONCLUSIONIntra-articularplacementoftheEndoButtoncanresultinfailureandpredisposetointra-articularmigrationAsimplescreeningarthroscopyafterfemoraltunneldrillingoraftersecuringtheEndoButtoncanidentifyintra-articularplacementandanew‘extra-articular”tunnelcanbecreatedREFERENCESAhmadCS,GardnerTR,GrohM,ArnoukJ,LevineWN.Mechanicalpropertiesofsofttissuefemoralfixationdevicesforanteriorcruciateligamentreconstruction.AmJSportsMed.2004;32(3):635-640.

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