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Klinische Ergebnisse der primären Kreuzbandreinsertion nach Palmer ohne Augmentation

Long term results following primary reconstruction of the cruciate ligaments without augmentation

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Zusammenfassung

In einer retrospektiven Studie wird der klinische Stellenwert der primären Kreuzbandreinsertion nach Palmer ohne Augmentation in der Behandlung akuter Kreuzbandrupturen anhand klinischer Langzeitbefunde von 51 Patienten diskutiert. Auf der Basis standardisierter Beurteilungskriterien ergab sich bei 38 Patienten ein gutes und sehr gutes Resultat, in elf Fällen wurde das Ergebnis als befriedigend und bei zwei Patienten als schlecht beurteilt. In zwei Fällen bestand ein deutlich positiver Lachman-Test in Verbindung mit einem Pivot-Shift-Phänomen Grad III. Eine mäßiggradige Instabilität mit einem Pivot-Shift Grad IIa bzw. IIb war bei zwölf Patienten festzustellen, während der Eingriff in 37 Fällen zur völligen Wiedererlangung der Gelenkstabilität geführt hat. Die Koinzidenz von Kreuzbandruptur und Innendbandläsion beeinträchtigt die postoperative Gelenkinstabilität signifikant (p<0,01). Die vorliegenden Ergebnisse lassen den Schluß zu, daß eine primäre Reinsertion des vorderen Kreuzbandes ohne synchrone Augmentation bei strenger Indikationsstellung, das heißt akute Ruptur, femoraler Ausriß und erhaltene Stabilität der Kollateralbänder, ein adäquates Operationsverfahren darstellt, das zur völligen Wiederherstellung der Gelenkstabilität geeignet ist.

Abstract

The clinical importance of primary cruciate ligament reconstruction without augmentation-plasty is discussed on the background of long term results following 51 operations. Based on standardized methods of evaluation 38 patients had a very good and good result, in eleven cases the operation lead to a fair and in two cases to a poor result. A significant instability with a pivot shift grade III was recorded in two cases; twelve patients showed a low degree of instability whereas 37 patients had regained full stability. The coincidence of a cruciate ligament lesion and a rupture of a collateral ligament had a negative influence on the postoperative long term result (p<0.01). Our results suggest that a primary repair without augmentation-plasty is a qualified procedure for stabilizing the knee joint in cases with an acute femoral rupture without accompanying collateral lesions. In patients with old ruptures or a complex joint lesion primary repair with augmentation is recommended.

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Author notes

  1. J. Raunest

    Present address: Chirurgische Universitätsklinik A, Moorenstraße 5, D-4000, Düsseldorf

Authors and Affiliations

  1. Abteilung für Allgemeine und Unfallchirurgie, Zentrum für Operative Medizin I der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    J. Raunest, E. Derra & C. Ohmann

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  2. E. Derra
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  3. C. Ohmann
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Raunest, J., Derra, E. & Ohmann, C. Klinische Ergebnisse der primären Kreuzbandreinsertion nach Palmer ohne Augmentation. Unfallchirurgie 17, 166–174 (1991). https://doi.org/10.1007/BF02588201

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