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Arthroskopie

, Volume 18, Issue 1, pp 11–14 | Cite as

Vorderes Kreuzband—was ist gesichert?

  • P. Lobenhoffer
  • J. D. Agneskirchner
Leitthema

Zusammenfassung

Die Ruptur des vorderen Kreuzbandes verursacht eine vermehrte anteriore Translation und Innenrotation der Tibia in strecknaher Stellung. Subjektiv bewirkt dies ein Unsicherheitsgefühl und eine verminderte Belastbarkeit, objektiv durch die pathologische Bewegungskurve eine höhere Inzidenz sekundärer Meniskus- und Knorpelschäden. Die Folgen eines Verlusts des vorderen Kreuzbandes sind stark vom körperlichen Aktivitätsprofil abhängig. Die Indikation zur Rekonstruktion des vorderen Kreuzbandes besteht v. a. bei jüngeren Patienten, bei hoher körperlicher Aktivität und bei Komplexverletzungen. Weltweit wird ganz überwiegend ein Ersatz mit einem ortständigen autologen Bindegewebetransplantat durchgeführt. Patellarsehnentransplantate, gebündelte Transplantate aus Semitendinosussehne und/oder Grazilis- und Quadrizepssehnentransplantate können dabei mit gleichem Erfolg verwendet werden. Der Eingriff kann arthroskopisch und über eine Miniarthrotomie mit gleichwertigem Ergebnis erfolgen. Wesentliche Erfolgskriterien sind die anatomisch genaue und mechanisch stabile Implantation des Bandersatzes, die Vermeidung von Konflikten mit knöchernen und ligamentären Strukturen der Interkondylärgrube und die adäquate Vorspannung des Bandersatzes. Günstigste Operationszeitpunkte sind die ersten 48 h nach der Verletzung und dann die Sekundärphase nach Abschwellung und Erreichen eines freien Bewegungsumfangs. Die Nachbehandlung sollte an die Primärfestigkeit der Fixationen des Bandersatzes angepasst werden. Der Prävention (Vermeidung verletzungstypischer Bewegungsabläufe) sollte künftig größere Bedeutung zugemessen werden.

Schlüsselwörter

Vorderes Kreuzband Vordere Kreuzbandruptur Therapie Kniebandverletzungen Kniebandoperationen 

Anterior cruciate ligament rupture—state of the art

Abstract

A rupture of the anterior cruciate ligament causes a pathological anterior translation and an increased internal rotation of the tibia. Subjective symptoms are instability and a decreased activity level. The pathological motion pattern of the knee results in a high incidence of secondary meniscus and chondral damage. The natural history is mainly dependent on the activity level of the subject. Indications for operative reconstruction are young age, high activity and complex ligament injuries of the knee. The anterior cruciate ligament can be reconstructed by an autologous tendon graft. Patellar tendon, hamstring tendon and quadriceps tendon grafts can be used. There are no systematic differences between the outcome related to these grafts. The procedure can be performed arthroscopically or using a mini-open technique with equal result. Main success factors are an anatomical placement of the graft with stable fixation, avoidance of impingement in the intercondylar notch and adequate pretension. Optimum time periods for surgery are the first 48 h after the injury and the secondary phase when the initial inflammation has subsided and the range of motion is free. The rehabilitation must be tailored to the initial mechanical strength of the graft fixation. Preventive training has been proven to be effective to reduce the incidence of anterior cruciate ligament ruptures in handball and soccer players and should be used more widely.

Keywords

Anterior cruciate ligament Anterior cruciate ligament rupture Operative treatment Knee ligament ruptures Knee surgery 

Notes

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Klinik für Unfall- und WiederherstellungschirurgieHenriettenstiftungHannover
  2. 2.Klinik für Unfall- und WiederherstellungschirurgieHenriettenstiftungHannover

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