Zusammenfassung
40 Patienten wurden fünf und zehn Jahre nach Naht des vorderen Kreuzbandes kontrolliert. Alle Patienten hatten klinisch ein insuffizientes vorderes Kreuzband. Fünf Jahre nach der Operation waren von den 40 Patienten 14 beschwerdefrei, zehn Jahre nach der Operation nur noch zwei. Die Arbeitsfähigkeit war fünf Jahre nach Naht bei neun, zehn Jahre nach Naht bei zwölf Patienten stark eingeschränkt. Nur elf Patienten hatten zehn Jahre nach Naht noch die gleiche Sportfähigkeit wie vor dem Unfall; bloß sechs Patienten bezeichneten sich als gleich leistungsfähig. Bei sechs Patienten mußte zwischen der ersten und der zweiten Nachkontrolle (fünf und zehn Jahre postoperativ) eine Meniskusoperation durchgeführt werden. Radiologisch fanden wir fünf Jahre nach Operation in 15% und zehn Jahre nach Operation in 30% eine Gonarthrose. 75% der Patienten mit einer Gonarthrose hatten eine partielle Meniskektomie hinter sich. Unsere Resultate bestätigen, daß eine Knieinstabilität, verursacht durch ein insuffizientes vorderes Kreuzband, vermehrt zu Meniskusrissen und Arthrose führt. Bei einer primären Naht des vorderen Kreuzbandes ohne Augmentation entwickelt sich praktisch immer eine funktionelle Instabilität. Diese Operationstechnik ist daher nicht zu empfehlen.
Abstract
The five-and ten-years review of 40 patients with primary suture of the anterior cruciate ligament without augmentation showed all patients to have a positive Lachman-Test. Five years postoperatively 14 patients had no complaints, after ten years, only two patients remained free of symptoms. Five years after suture nine patients were limited at work, while after ten years this number had risen to twelve. Ten years after the suture only eleven patients had the same sporting abilities as before the accident; only six patients retained their level of performance. Six patients needed a meniscus-operation between the first and second review (five and ten years postoperatively). Radiologically we found signs of gonarthrosis in 15% at five years and 30% at ten years. 75% of the patients with gonarthrosis had had partial meniscectomy. Our results confirm that instability caused by an insufficient anterior cruciate ligament leads to higher incidence of meniscal tears and osteoarthritis. A primary suture of the anterior cruciate ligament without augmentation almost allways leads to functional instability. This surgical procedure therefore is not recommended.
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Blatter, G., Tissi, R. Ist die Naht des rupturierten vorderen Kreuzbandes ohne Augmentation sinnvoll?. Unfallchirurgie 17, 232–235 (1991). https://doi.org/10.1007/BF02588692
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DOI: https://doi.org/10.1007/BF02588692