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Arthroskopische Refixation proximaler Ausrisse des vorderen Kreuzbands

Arthroscopic refixation of proximal avulsion of the anterior cruciate ligament

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Die arthroskopisch gestützte Refixation einer akuten proximalen Ruptur des vorderen Kreuzbands (VKB) hat das Ziel, die anatomische und biomechanische Integrität des VKB wiederherzustellen. Banderhaltende Verfahren haben in den letzten Jahren wieder neuen Aufwind bekommen. Neben der Weiterentwicklung von Naht- bzw. Refixationsmaterialien und der operativen Technik hat sich aber auch die Indikationsstellung als entscheidender Faktor für das postoperative Ergebnis herausgestellt. Indikationen stellen akute, proximale VKB-Rupturen mit intakter Ligamentsubstanz dar. Entsprechend kann die abschließende Entscheidung zur Ankerrefixation erst intraoperativ erfolgen. Hierbei wird unter arthroskopischer Sicht die intakte Ligamentstruktur mittels Fiberwire-Fäden armiert und an der femoralen Insertion des VKB mit einem knotenlosen Anker refixiert. Anschließend kann additiv eine Mikrofrakturierung erfolgen. Erste Studien zeigen gute klinische Ergebnisse; die Versagensrate liegt derzeit bei bis zu 15 %.

Abstract

The aim of arthroscopically assisted refixation combined with microfracturing of acute proximal anterior cruciate ligament ruptures (ACL) is to restore the anatomical and biomechanical properties of the native ACL. Due to several reasons ACL repair techniques have gained new interest. In addition to the newly developed suture materials, arthroscopic repair techniques and a better patient selection, favored indications are acute proximal ACL tears with good tissue quality of the residual ligament. Therefore, the final decision on treatment is possible during intraoperative arthroscopic examination of the ACL with a probe. After debridement of the femoral ACL insertion, a curved lasso is used to place a suture through the ACL. A drill guide is used to ensure positioning of the anchor in the center of the ACL insertion zone. Microfracturing holes around the femoral footprint are made with an awl to enhance healing properties of the ACL. Initial clinical studies have shown good results and the revision rate is currently approximately 15%.

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Authors and Affiliations

  1. Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland

    Andrea Achtnich MD,  Knut Beitzel MD &  Andreas B. Imhoff MD

  2. Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Berlin, Deutschland

    Wolf Petersen MD

Authors
  1. Andrea Achtnich MD
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  2. Knut Beitzel MD
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  3. Andreas B. Imhoff MD
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  4. Wolf Petersen MD
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Corresponding author

Correspondence to Andrea Achtnich MD.

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Interessenkonflikt

W. Petersen und K. Beitzel weisen auf folgende Beziehungen hin. W. Petersen: Beratertätigkeit für Otto Bock Health Care, Karl Storz und AAP Implantate, Vertragshonorar von Plasmaconcept; K. Beitzel: Arthrex. A. Achtnich und A.B. Imhoff geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Achtnich, A., Beitzel, K., Imhoff, A.B. et al. Arthroskopische Refixation proximaler Ausrisse des vorderen Kreuzbands. Arthroskopie 31, 207–210 (2018). https://doi.org/10.1007/s00142-017-0182-6

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  • DOI: https://doi.org/10.1007/s00142-017-0182-6

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