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Komplikationen nach Kreuzbandersatzplastiken

Complications after cruciate ligament reconstruction

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Zusammenfassung

Kreuzbandersatzplastiken sind Wahloperationen, die überwiegend bei jüngeren Menschen durchgeführt werden. Komplikationen sind deshalb besonders tragisch. Bereits die Diagnostik und Indikationsstellung beinhaltet Komplikationsmöglichkeiten. Die Komplexität einer Verletzung muss vollständig erfasst werden. Um intraoperative Komplikationen zu vermeiden, ist es wichtig, dass der Operateur umfassende anatomische Kenntnisse hat. Es gibt eine Vielzahl von Stabilisierungstechniken. Jede dieser Techniken hat eine Lernkurve und birgt spezielle Risiken. Ein vorausgehendes Training des Chirurgen am Präparat erscheint deshalb nützlich. Die Häufigkeit von Thrombembolien soll durch evidenzbasierte Prophylaxe minimiert werden. Bei Thrombose, Embolie und Infekt ist eine frühe Diagnostik und Behandlung (ggf. unter Einbindung anderer Fachdisziplinen) erforderlich.

Postoperative Bewegungsstörungen wie die Arthrofibrose können durch die richtige Wahl des Operationszeitpunktes und der Operationstechnik weitgehend vermieden werden. Sollten sie dennoch auftreten, muss die Beweglichkeit unter besonderer Berücksichtigung der Streckung frühzeitig wiederhergestellt werden. Ein Versagen der Kreuzbandersatzplastiken während der Rehabilitation und Wiedereingliederung in den Sport beruht meist auf Überlastung. Es ist daher sinnvoll, die Stabilität des rekonstruierten Bandapparats zum jeweiligen Zeitpunkt und Motorik sowie Trainingszustand des Patienten zu berücksichtigen. Ein mittelfristiges Versagen der Bandplastik beruht häufig auf operationstechnischen Fehlern. Nur selten tritt ein sog. „biologisches Versagen“ auf.

Abstract

Reconstruction of the cruciate ligaments is elective surgery performed mainly on younger people. Therefore, complications are especially tragic. Diagnostics and indications include the possibility of complications. The complexity of an injury must be thoroughly appreciated, and to avoid intraoperative complications, it is important for the surgeon to have a comprehensive anatomical knowledge. A great number of stabilization procedures exist, each with its own learning curve and specific risks. Therefore, lab training of surgeons appears reasonable. The frequency of thromboembolism in the early postoperative stage should be minimized by evidence-based prophylaxis. Early diagnostics and treatment of thrombosis, embolism, and infection are required, and consultants should be brought in if necessary.

Postoperative movement malfunction as arthrofibrosis can be widely avoided by the correct choice of the point for surgery and the surgical procedure. If arthrofibrosis occurs, mobility must be restored at an early stage, with special focus on full extension. A failure of reconstructed cruciate ligaments during rehabilitation and reintegration into sports is mostly based on overload of the ligaments. The stability of the reconstructed ligaments at the respective time point and motor function as well as the patient’s physical condition should be reasonably considered. A medium-term graft failure is often based on surgical errors. So-called biological failure occurs only rarely.

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Authors and Affiliations

  1. OCM – Klinik für Orthopädische Chirurgie München, Steinerstraße 6, 81369, München, Deutschland

    H.O. Mayr & C. Zeiler

  2. Universitätsklinik und Poliklinik für Orthopädie, Martin-Luther-Universität, Halle-Wittenberg, Deutschland

    H.O. Mayr

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Mayr, H., Zeiler, C. Komplikationen nach Kreuzbandersatzplastiken. Orthopäde 37, 1080–1087 (2008). https://doi.org/10.1007/s00132-008-1306-5

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