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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Treatment of chronic collateralinjuries
Prof. N. Reha Tandogan, M.D
Ortoklinik / Çankaya Orthopaedics, Ankara
Dr. Asım Kayaalp Dr. Mümtaz AlpaslanDr. Mahmut Kış Dr. Kürşat Teker Dr. Uğur Gönç Dr. Altuğ TanrıöverDr. Uğur Şaylı Dr. Gürkan ErkulaDr. Mazhar Tokgözoğlu Dr. Bülent AtillaDr. Muharrem Yazıcı Phys. İpek İkiz
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
31y, M
Motor vechicle accident 1 year ago
Lateral tibial plateau fracture fixed withscrews
Concomittant lateral meniscectomy
Chief complaint instability and inability to run
Pain, crepitus and effusion
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
Valgus stress testing
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Antero-posterior laxity
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Zorlamalı grafiler
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Patello-femoral joint
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Coronal sections
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Cruciates
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
Menisci
medial
lateral
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
2. Contra-lateral ST graft
for MPFL reconstrucion
3. Contra-lateral gracilis
graft for superficial MCL
and posterior oblique
ligament reconstruction
1. Anatomical single
bundle ACL
reconsrtruction using
ST-G grafts from the
same knee
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
Canka
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Chronic medial injuries
Untreated or missedinjuries
Residual laxity afterconservative treatment
Residual laxity afterprevious surgery
Graft sources ?
Hardware ?
Tunnels ?
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Stress X-rays
Objective quantification of laxity
Post-op evaluation of results
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Surgical principles
Verify extremity alignment
Femoral osteotomy for valgus knees ?
Reconstruct cruciates
Reconstruct medial side
sMCL
POL
Cartilage & meniscal regeneration/ replacementCan
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Historical procedures
Pesplasty
Capsular plication
Bone block advancement Robust but lax MCL
Changes isometry
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Options for reconstruction
Reconstruction of sMCL only
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Isolated SMCL reconstruction
Usually combined withplication/advancementof PMC
% 83 success, 2mm(-) valgus in stress X-rays Yoshiya S. Am. J. Sports Med.
2005; 33; 1380
Does not address laxityof POL in full extension
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Single femoral tunnel sMCLand POL reconstruction
Less than 2 mm medial opening22/24 patients Kim SJ. J Bone Joint Surg Br. 2008; 90(10):1323-
7.
% 98 IKDC A or B in 61 patients Lind M. J Bone Joint Surg Br. 2008;90(10):1323-
7.
Early failure under cyclic loadingin cadaver testing LaPrade RF. Clin Orthop Relat Res (2012)
470:806–814Lind M, 2008Can
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICSÇANKAYA ORTHOPEDICS
Anatomical reconstructionof sMCL, dMCL& POL
2 seperate grafts, 4 tunnelsin anatomical insertions
28 patients, 6mo-3yrs f-up
IKDC score 76
Valgus opening 1.3 mm• LaPrade RF. Clin Orthop Relat Res
(2012) 470:806–814
Coobs BR,
AJSM 2009Canka
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Dr. N. Reha Tandoğan
ÇANKAYA ORTHOPEDICS
TEŞEKKÜRLERwww.ortoklinik.com
www.cankayaortopedi.com
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