Der Chirurg

, Volume 85, Issue 10, pp 888–894 | Cite as

Verletzungen des vorderen Kreuzbandes bei Sportlern

Leitthema
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Zusammenfassung

Vordere Kreuzbandrupturen stellen für Sportler schwerwiegende Verletzungen dar, die nicht selten mit Begleitverletzungen einhergehen und zu relevanten kinematischen Veränderungen des femorotibialen Roll-Gleit-Mechanismus des Kniegelenkes führen. Instabilität und Sekundärschäden der Menisken und des Knorpels können für Sportler karrierelimitierend sein. Zur Wiedererlangung der sportlichen Leistungsfähigkeit sowie zur Vermeidung sekundärer Folgeschäden stellt der vordere Kreuzbandersatz daher den Goldstandard der Therapie einer vorderen Kreuzbandruptur dar. Einem ständigen Wandel unterliegend können mit den aktuellen Techniken des vorderen Kreuzbandersatzes individuelle Anforderungen der Sportler sowie sportartspezifische Aspekte berücksichtigt werden. Hierfür stehen verschiedene Transplantate, Fixationsmöglichkeiten und Operationstechniken zur Verfügung, die individuell abgestimmt werden können. Wesentlich für die Wiederherstellung des kinematischen Roll-Gleit-Mechanismus und die Stabilität sind anatomisch korrekt positionierte Bohrkanäle in Verbindung mit stabilen Transplantatverankerungen. Unter Berücksichtigung dieser individuell abgestimmten operationstechnischen Aspekte ist eine frühfunktionelle Nachbehandlung, die den Rehabilitationsverlauf maßgeblich beeinflussen kann, möglich und es können gute Funktions- und Stabilitätsergebnisse erzielt werden, sodass nach Wiedererlangung der neuromuskulären Fähigkeiten, der Kraft und Koordination über ein sportartspezifisches Training die sportliche Leistungsfähigkeit wiedererlangt werden kann.

Schlüsselwörter

Vorderes Kreuzband Begleitverletzungen Diagnosestellung Rekonstruktion Funktionelles Ergebnis 

Injuries of the anterior cruciate ligament in athletes

Abstract

Anterior cruciate ligament ruptures represent serious injuries for athletes which are often associated with accompanying injuries and lead to relevant kinematic alterations in the femorotibial roll-glide mechanism of the knee joint. Instability resulting in recurrent giving way events, as well as instability-related meniscal and cartilage lesions can cause functional long-term impairment that may limit the athlete’s career. Anterior cruciate ligament replacement is therefore considered to be the gold standard for recovery of physical performance and to prevent secondary meniscal and cartilage damage. Continuous changes in the reconstruction of the anterior cruciate ligament have led to a variety of different methods, including graft choice, fixation devices and surgical techniques, which support the consideration of individual requirements of the athlete as well as sport-specific aspects. One of the main factors for restoring stability and the physiological kinematic roll-glide mechanism of the knee is an anatomical tunnel placement as well as a stable graft fixation in the tibia and femur. By achieving of these fundamental technical requirements an early functional rehabilitation and accelerated recovery of neuromuscular skills, strength and coordination can be achieved, so that an early return to sport activities is possible.

Keywords

Anterior cruciate ligament Associated injuries Diagnosis Reconstruction Functional outcome 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Shafizadeh, M.M. Schneider und B. Bouillon geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Acevedo RJ, Rivera-Vega A, Miranda G, Micheo W (2014) Anterior cruciate ligament injury: identification of risk factors and prevention strategies. Curr Sports Med Rep 13(3):186–191. doi:10.1249/JSR.0000000000000053PubMedCrossRefGoogle Scholar
  2. 2.
    Aglietti P, Giron F, Cuomo P et al (2007) Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res 454:108–113. doi:10.1097/BLO.0b013e31802baaf4PubMedCrossRefGoogle Scholar
  3. 3.
    Alentorn-Geli E, Mendiguchia J, Samuelsson K et al (2014) Prevention of anterior cruciate ligament injuries in sports. Part I: systematic review of risk factors in male athletes. Knee Surg Sports Traumatol Arthrosc 22(1):3–15. doi:10.1007/s00167-013-2725-3Google Scholar
  4. 4.
    Alentorn-Geli E, Mendiguchia J, Samuelsson K et al (2014) Prevention of non-contact anterior cruciate ligament injuries in sports. Part II: systematic review of the effectiveness of prevention programmes in male athletes. Knee Surg Sports Traumatol Arthrosc 22(1):16–25. doi:10.1007/s00167-013-2739-xGoogle Scholar
  5. 5.
    Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73(2):260–267PubMedGoogle Scholar
  6. 6.
    Bere T, Bahr R (2014) Injury prevention advances in alpine ski racing: harnessing collaboration with the International Ski Federation (FIS), long-term surveillance and digital technology to benefit athletes. Br J Sports Med 48(9):738. doi:10.1136/bjsports-2014-093528PubMedCrossRefGoogle Scholar
  7. 7.
    Beynnon B, Howe JG, Pope MH et al (1992) The measurement of anterior cruciate ligament strain in vivo. Int Orthop 16(1):1–12PubMedCrossRefGoogle Scholar
  8. 8.
    Beynnon BD, Johnson RJ, Abate JA et al (2005) Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med 33(11):1751–1767. doi:10.1177/0363546505279922PubMedCrossRefGoogle Scholar
  9. 9.
    Beynnon BD, Johnson RJ, Fleming BC et al (2002) Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 84-A(9):1503–1513Google Scholar
  10. 10.
    Beynnon BD, Uh BS, Johnson RJ et al (2005) Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med 33(3):347–359PubMedCrossRefGoogle Scholar
  11. 11.
    Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23(6):573–578PubMedGoogle Scholar
  12. 12.
    Boden BP, Griffin LY, Garrett WE Jr (2000) Etiology and prevention of noncontact ACL injury. Phys Sportsmed 28(4):53–60. doi:10.3810/psm.2000.04.841PubMedCrossRefGoogle Scholar
  13. 13.
    Brand J Jr, Weiler A, Caborn DN et al (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28(5):761–774PubMedGoogle Scholar
  14. 14.
    Brown CH Jr, Wilson DR, Hecker AT, Ferragamo M (2004) Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading. Arthroscopy 20(9):922–935. doi:10.1016/j.arthro.2004.06.032PubMedCrossRefGoogle Scholar
  15. 15.
    Bull AM, Andersen HN, Basso O et al (1999) Incidence and mechanism of the pivot shift. An in vitro study. Clin Orthop Relat Res 363:219–231PubMedCrossRefGoogle Scholar
  16. 16.
    Christel M, Witvoet J, Pelisse F et al (1986) Instrumental measurement of the anteroposterior laxity of the normal and lax knee. Rev Chir Orthop Reparatrice Appar Mot 72(Suppl 2):115–118PubMedGoogle Scholar
  17. 17.
    Colby S, Francisco A, Yu B et al (2000) Electromyographic and kinematic analysis of cutting maneuvers. Implications for anterior cruciate ligament injury. Am J Sports Med 28(2):234–240PubMedGoogle Scholar
  18. 18.
    Devita P, Skelly WA (1992) Effect of landing stiffness on joint kinetics and energetics in the lower extremity. Med Sci Sports Exerc 24(1):108–115PubMedGoogle Scholar
  19. 19.
    Donaldson WF III, Warren RF, Wickiewicz T (1985) A comparison of acute anterior cruciate ligament examinations. Initial versus examination under anesthesia. Am J Sports Med 13(1):5–10PubMedCrossRefGoogle Scholar
  20. 20.
    Ejerhed L, Kartus J, Sernert N et al (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31(1):19–25PubMedGoogle Scholar
  21. 21.
    Ettlinger CF, Johnson RJ, Shealy JE (1995) A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med 23(5):531–537PubMedCrossRefGoogle Scholar
  22. 22.
    Fink C, Hoser C, Hackl W et al (2001) Long-term outcome of operative or nonoperative treatment of anterior cruciate ligament rupture – is sports activity a determining variable? Int J Sports Med 22(4):304–309. doi:10.1055/s-2001-13823PubMedCrossRefGoogle Scholar
  23. 23.
    Foster TE, Wolfe BL, Ryan S et al (2010) Does the graft source really matter in the outcome of patients undergoing anterior cruciate ligament reconstruction? An evaluation of autograft versus allograft reconstruction results: a systematic review. Am J Sports Med 38(1):189–199. doi:10.1177/0363546509356530Google Scholar
  24. 24.
    Giron F, Cuomo P, Edwards A et al (2007) Double-bundle „anatomic“ anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23(1):7–13. doi:10.1016/j.arthro.2006.08.008PubMedCrossRefGoogle Scholar
  25. 25.
    Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8(3):141–150PubMedGoogle Scholar
  26. 26.
    Griffin LY, Albohm MJ, Arendt EA et al (2006) Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med 34(9):1512–1532. doi:10.1177/0363546506286866PubMedCrossRefGoogle Scholar
  27. 27.
    Grood ES, Suntay WJ, Noyes FR, Butler DL (1984) Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament. J Bone Joint Surg Am 66(5):725–734PubMedGoogle Scholar
  28. 28.
    Hinterwimmer S, Engelschalk M, Sauerland S et al (2003) Operative or conservative treatment of anterior cruciate ligament rupture: a systematic review of the literature. Unfallchirurg 106(5):374–379. doi:10.1007/s00113-003-0596-7PubMedCrossRefGoogle Scholar
  29. 29.
    Jansson KA, Linko E, Sandelin J, Harilainen A (2003) A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 31(1):12–18PubMedGoogle Scholar
  30. 30.
    Katz JW, Fingeroth RJ (1986) The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. Am J Sports Med 14(1):88–91PubMedCrossRefGoogle Scholar
  31. 31.
    Kessler MA, Behrend H, Henz S et al (2008) Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 16(5):442–448. doi:10.1007/s00167-008-0498-xPubMedCrossRefGoogle Scholar
  32. 32.
    LaPrade RF, Burnett QM II (1994) Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study. Am J Sports Med 22(2):198–202 (discussion 203)PubMedCrossRefGoogle Scholar
  33. 33.
    LaPrade RF, Burnett QM II, Veenstra MA, Hodgman CG (1994) The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. With correlation of magnetic resonance imaging to arthroscopic findings in symptomatic knees. Am J Sports Med 22(6):739–745PubMedCrossRefGoogle Scholar
  34. 34.
    Lindblom H, Walden M, Carlfjord S, Hagglund M (2014) Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after a randomised controlled trial. Br J Sports Med. doi:10.1136/bjsports-2013-093298Google Scholar
  35. 35.
    Muller B, Hofbauer M, Wongcharoenwatana J, Fu FH (2013) Indications and contraindications for double-bundle ACL reconstruction. Int Orthop 37(2):239–246. doi:10.1007/s00264-012-1683-6PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Muller B, Rupp S, Kohn D, Seil R (2000) Donor site problems after anterior cruciate ligament reconstruction with the middle third of the patellar ligament. Unfallchirurg 103(8):662–667PubMedCrossRefGoogle Scholar
  37. 37.
    Myklebust G, Engebretsen L, Braekken IH et al (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13(2):71–78PubMedCrossRefGoogle Scholar
  38. 38.
    Myklebust G, Holm I, Maehlum S et al (2003) Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med 31(6):981–989PubMedGoogle Scholar
  39. 39.
    Noyes FR, Mangine RE, Barber S (1987) Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 15(2):149–160PubMedCrossRefGoogle Scholar
  40. 40.
    Olsen OE, Myklebust G, Engebretsen L, Bahr R (2004) Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med 32(4):1002–1012PubMedCrossRefGoogle Scholar
  41. 41.
    Olsen OE, Myklebust G, Engebretsen L et al (2003) Relationship between floor type and risk of ACL injury in team handball. Scand J Med Sci Sports 13(5):299–304PubMedCrossRefGoogle Scholar
  42. 42.
    Passler HH, Shelbourne KD (1993) Biological, biomechanical and clinical concepts of after-care following knee ligament surgery. Orthopade 22(6):421–435PubMedGoogle Scholar
  43. 43.
    Peters G, Wirth CJ, Kohn D (1997) Comparison of knee ligament scores and rating systems. Z Orthop Ihre Grenzgeb 135(1):63–69. doi:10.1055/s-2008-1039557PubMedCrossRefGoogle Scholar
  44. 44.
    Renstrom P, Arms SW, Stanwyck TS et al (1986) Strain within the anterior cruciate ligament during hamstring and quadriceps activity. Am J Sports Med 14(1):83–87PubMedCrossRefGoogle Scholar
  45. 45.
    Scheffler SU, Sudkamp NP, Gockenjan A et al (2002) Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques: the impact of fixation level and fixation method under cyclic loading. Arthroscopy 18(3):304–315PubMedCrossRefGoogle Scholar
  46. 46.
    Shelbourne KD, Facibene WA, Hunt JJ (1997) Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 5(4):229–233. doi:10.1007/s001670050055PubMedCrossRefGoogle Scholar
  47. 47.
    Shelburne KB, Pandy MG (1997) A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions. J Biomech 30(2):163–176PubMedCrossRefGoogle Scholar
  48. 48.
    Siebold R, Zantop T (2009) Anatomic double-bundle ACL reconstruction: a call for indications. Knee Surg Sports Traumatol Arthrosc 17(3):211–212. doi:10.1007/s00167-008-0715-7PubMedCrossRefGoogle Scholar
  49. 49.
    Smith TO, Postle K, Penny F et al (2013) Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee. doi:10.1016/j.knee.2013.10.009Google Scholar
  50. 50.
    Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med 21(4):535–539PubMedCrossRefGoogle Scholar
  51. 51.
    Stanitski CL (1996) Conservative treatment of complete ACL tears. J Bone Joint Surg Br 78(4):681PubMedGoogle Scholar
  52. 52.
    Strehl A, Eggli S (2007) The value of conservative treatment in ruptures of the anterior cruciate ligament (ACL). J Trauma 62(5):1159–1162. doi:10.1097/TA.0b013e31805006e7PubMedCrossRefGoogle Scholar
  53. 53.
    Suomalainen P, Jarvela T, Paakkala A et al (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40(7):1511–1518. doi:10.1177/0363546512448177PubMedCrossRefGoogle Scholar
  54. 54.
    Suomalainen P, Kannus P, Jarvela T (2013) Double-bundle anterior cruciate ligament reconstruction: a review of literature. Int Orthop 37(2):227–232. doi:10.1007/s00264-012-1680-9PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Suomalainen P, Moisala AS, Paakkala A et al (2011) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 39(8):1615–1622PubMedCrossRefGoogle Scholar
  56. 56.
    Swart E, Redler L, Fabricant PD et al (2014) Prevention and screening programs for anterior cruciate ligament injuries in young athletes: a cost-effectiveness analysis. J Bone Joint Surg Am 96(9):705–711. doi:10.2106/JBJS.M.00560PubMedCrossRefGoogle Scholar
  57. 57.
    Tandogan RN, Taser O, Kayaalp A et al (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12(4):262–270. doi:10.1007/s00167-003-0398-zPubMedCrossRefGoogle Scholar
  58. 58.
    Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M (2012) Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 11:CD008413. doi:10.1002/14651858.CD008413.pub2PubMedGoogle Scholar
  59. 59.
    Tyler TF, McHugh MP, Gleim GW, Nicholas SJ (1998) The effect of immediate weightbearing after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 357:141–148PubMedCrossRefGoogle Scholar
  60. 60.
    Weiler A, Scheffler S, Hoher J (2002) Transplant selection for primary replacement of the anterior cruciate ligament. Orthopade 31(8):731–740PubMedCrossRefGoogle Scholar
  61. 61.
    Yoshiya S, Nagano M, Kurosaka M et al (2000) Graft healing in the bone tunnel in anterior cruciate ligament reconstruction. Clin Orthop Relat Res 376:278–286PubMedCrossRefGoogle Scholar
  62. 62.
    Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36(1):65–72PubMedCrossRefGoogle Scholar
  63. 63.
    Zhu Y, Tang RK, Zhao P et al (2013) Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 21(5):1085–1096. doi:10.1007/s00167-012-2073-8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik für Orthopädie, Unfallchirurgie und SporttraumatologieUniversität Witten/Herdecke am Klinikum Köln Merheim, Abteilung des Berufsgenossenschaftlichen Klinikums Bergmannsheil Bochum am Standort KölnKölnDeutschland

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