Patellarsehnenruptur
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Zusammenfassung
Operationsziel
Wiederherstellung der Funktion des Streckapparats am Kniegelenk mittels Internal Bracing und transossärer Augmentation. Die sofortige hohe Primärstabilität ermöglicht eine zügige Mobilisation.
Indikationen
Akute (auch subakute) sowie chronische Patellarsehnenruptur bzw. -insuffizienz. Distale Patellapolfrakturen.
Kontraindikationen
Schwere Weichteilschäden oder Infektionen am Kniegelenk, polytraumatisierte Patienten.
Operationstechnik
Medianer Zugang ventral über Lig. patellae. Anlegen von je 2 Querbohrungen in der distalen Patella und Tuberositas tibiae mit 2,4-mm-Bohrer. Einziehen von 2 FiberTapes® (Arthrex, Naples, FL, USA) in X‑ und O‑Konfiguration als Internal Bracing des Lig. patellae. Fixieren der Tapes durch manuelles Verknoten nach Röntgenkontrolle und korrekter Einstellung der Patella. Adaptierende Nähte der Sehnenstümpfe mit resorbierbarem Nahtmaterial.
Weiterbehandlung
Sofortige Bewegungsübungen passiv auf der CPM-Schiene („continuous passive motion“) bis 90°-Flexion. Initial zwei Wochen 20-kg-Teilbelastung, danach Belastungsaufbau in Streckorthese für die ersten 6. Wochen postoperativ. Isometrische Beübung ab 3. Woche postoperativ. Flexion passiv bis 110° ab 4. Woche (schmerzadaptiert). Ab 7. Woche aktive Streckübungen und volle Bewegungsfreigabe des Kniegelenks.
Ergebnisse
In über 10 Jahren klinischer Anwendung zeigen sich in der akuten als auch in der chronischen Patellarsehnenruptur durchgehend positive Ergebnisse. Diese Ergebnisse decken sich mit denen der aktuellen Literatur.
Schlüsselwörter
Ligamentum patellae Sehnenverletzung Patellapolfraktur Revisionsoperation Transossäre AugmentationPatellar tendon ruptures
Abstract
Objective
To report a surgical technique for the treatment of patellar tendon ruptures augmented with an internal brace suture tape.
Indications
Acute patellar tendon ruptures, fractures of the distal patellar pole, chronic insufficiency of the patellar tendon or revision surgery for failed repairs.
Contraindications
Severe damage to the surrounding soft tissue. Local infection. Life-threatening conditions.
Surgical technique
Direct longitudinal anterior approach to the patellar tendon. Two parallel transosseous bone tunnels are drilled in the patella and tibial tuberosity with a 2.4 mm drill bit. Two separate FiberTapes® (Arthrex, Naples, FL; USA) are shuttled through the proximal and distal bone tunnels around the tendon in “X” and “O” type configuration. Patellar height is reestablished under fluoroscopic control and both FiberTapes are tied down. Both tendon ends are debrided and readapted with absorbable sutures.
Postoperative management
Passive motion exercise to 90° of flexion from day 1. Partial load to 20 kg of body weight with knee in locked full extension brace during first 2 weeks. Isometric exercises from week 3. Passive flexion to 110° from week 4 (adapted to pain). Free active range of motion and weight bearing from week 7.
Results
In more than 10 years of clinical application, positive results were continuously found in acute as well as chronic patellar tendon ruptures. These results are consistent with those in the current literature.
Keywords
Patellar ligament Tendon injuries Patellar pole fracture Revision surgery Transosseous augmentationNotes
Einhaltung ethischer Richtlinien
Interessenkonflikt
V. Schütte, A. Schmidt-Hebbel, A.B. Imhoff und A. Achtnich geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Literatur
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