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Kreuzbandrekonstruktion durch autologe Patellarsehnentransplantation

Kann im Hinblick auf den Transplantatumbau und die Revaskularisierung eine dauerhafte Stabilität erwartet werden?

Anterior cruciate reconstruction with a free patellar tendon graft

Is it possible to achieve a durable stability considering graft remodelling and revascularisation? (laser doppler flowmetry, histology and stability tests)

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Zusammenfassung

Grundlagen

Die Technik der Patellarsehnentransplantation stellt derzeit den sogenannten „Golden standard” der Kreuzbandchirurgie dar. Inwieweit dieses freie Transplantat vital bleibt, soll durch die Durchblutungsmessung mit Hilfe Flowmessung, histologischer Untersuchung und klinischer Beurteilung bewertet werden.

Methodik

Bei 10 Patienten wurde 8 bis 12 Monate postoperativ die intraligamentäre Durchblutungssituation mittels Laserdoppler-Flowmetrie im Rahmen einer Arthroskopie bestimmt und einer Kontrollgruppe mit intakten vorderem Kreuzband gegenübergestellt. Gleichzeitig erfolgte die Entnahme von Biopsien aus dem Transplantat. Zur klinischen Beurteilung wurden 34 Patienten durchschnittlich 3,5 Jahre postoperativ nachuntersucht und nach dem Lysholm- und HSS-Score bewertet. Die Stabilitätskontrolle erfolgte ausschließlich durch eine klinische Untersuchung, nachdem die Verläßlichkeit der manuellen Stabilitätsuntersuchung durch Vergleich mit einem computergestützten Testsystem bewiesen werden konnte.

Ergebnisse

Die Flowmetrie zeigte in den Transplantaten Durchblutungswerte von lediglich einem Zehntel des physiologischen Kreuzbandes. Histologisch fand sich vitales Sehnengewebe mit geordnetem Faserverlauf, jedoch abschnittsweise waren auch Narbengewebe und myxoide Degenerationen nachzuweisen.

Bei der klinischen Stabilitätsuntersuchung waren 85,3% der Patienten bandstabil, 88,3% erhielten die Bewertung „gut” im Lysholm-Score, 85,3% im HSS-Score.

Schlußfolgerungen

Das freie Patellarsehnentransplantat ist sowohl bei der Durchblutungsmessung als auch histologischen Untersuchung vital, stellt jedoch lediglich ein Ersatzgewebe mit verminderter Belastbarkeit dar. Die vorliegenden Erkenntnisse beeinflussen die medizinische Bewertung bezüglich Dauer- und Spitzenbelastung.

Summary

Introduction

At the moment the transplantation of free patellar tendon graft is the so called „Golden standard” in surgery of the anterior cruciate ligament. The vitality of the graft shall be assessed by the measurement of the blood circulation as well as by histologic investigation and clinical evaluation.

Methods

In 10 patients the intraligamentary blood circulation was arthroscopically determined by laser flowmetry 8 to 12 months postoperatively and compared with a control group with uninjured anterior cruciate ligament. At the same time probes were taken out of the graft. For clinical assessment 34 patients were investigated 3.5 years after procedure on average and evaluated according to Lysholm-and HSS-score. After having proved the accuracy of the manual assessment of the joint stability by a comparison with a computer-aided test system, the stability control was exclusively performed by clinical investigation.

Results

The blood circulation of the grafts measured by flowmetry was only a tenth of that of healthy anterior cruciate ligaments. The histologic investigation showed vital tendon tissue with well ordered formation of fibres, partially interspersed by scar tissue and myxoid degeneration. The clinical investigation showed a stable joint in 85.3% of the patients. 88.3% of the patients were classified „good” in Lysholm, 85.3% in HSS-score.

Conclusion

The free patellar tendon graft is considered to be vital both by measurement of the blood circulation and by histologic investigation. Nevertheless it is only a substitution tissue with a minor load bearing capacity. The results were have to hand are in influencing the medical evaluation concerning permanent- and top-stress in sports.

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Authors and Affiliations

  1. Institut für Pathologische Anatomie, Universität Graz, Graz, Austria

    S. Lax

  2. Department für Unfallchirurgie, Universitätsklinik für Chirurgie, Auenbruggerplatz 1, A-8036, Graz

    J. M. Passler

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Passler, J.M., Lax, S. Kreuzbandrekonstruktion durch autologe Patellarsehnentransplantation. Acta Chir Austriaca 25, 118–125 (1993). https://doi.org/10.1007/BF02602144

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