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Surgical treatment of ligamentous instability after total knee arthroplasty

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Summary

During the period of January 1, 1972 through October 31, 1982 seven knees in seven patients had ligamentous reconstructions for instability following total knee arthroplasty. The type of ligamentous instability included severe medial instability in six and a combined severe medial and mild lateral instability in one patient. The surgical technique utilized to reconstruct the ligaments included proximal and distal advancement of the medial collateral ligament. In five of the seven, additional soft tissue surgery was combined with tightening of the medial collateral ligament. Unfortunately, ligamentous reconstruction failed to restore stability to the knee in any of the seven patients. Four patients required revision total knee arthroplasty. Instability of the knee necessitated full-time support with a brace and the seventh patient manages his instability without a brace. Ligamentous reconstruction without component revision is inappropriate in the treatment of the unstable knee following total knee arthroplasty.

Zusammenfassung

In der Zeit vom 1. Januar 1972 bis 31. Oktober 1982 erfolgte bei 7 Kniegelenken von 7 Patienten eine Bandrekonstruktion wegen Instabilität nach Implantation einer Kniegelenk-Totalprothese. Bei 6 Patienten bestand eine schwere Instabilität des medialen Längsbandes und bei einem Patienten eine schwere mediale Instabilität, kombiniert mit einer leichten lateralen Instabilität. Die operative Technik zur Wiederherstellung der Bandfestigkeit bestand in einer Versetzung des proximalen und distalen Ansatzes des medialen Längsbandes. In 5 der 7 Fälle wurden zusätzliche Weichteiloperationen mit der Anspannung des medialen Längsbandes kombiniert. Bedauerlicherweise hat die Rekonstruktion des Bandapparates bei der Wiederherstellung der Kniegelenkstabilität in allen 7 Fällen versagt. Bei 4 Patienten war eine Auswechslung der Knieprothese erforderlich. Die Knie-Instabilität erforderte die dauernde Versorgung mit einer Orthese, nur einer der 7 Patienten kam ohne eine Orthese mit der Instabilität zurecht. Eine Bandrekonstruktion ohne eine Auswechslung des Kunstgelenkes ist ein ungeeignetes Vorgehen bei der Behandlung einer instabilen Kniegelenk-Totalprothese.

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Pritsch, M., Fitzgerald, R.H. & Bryan, R.S. Surgical treatment of ligamentous instability after total knee arthroplasty. Arch. Orth. Traum. Surg. 102, 154–158 (1984). https://doi.org/10.1007/BF00575224

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  • DOI: https://doi.org/10.1007/BF00575224

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