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Vordere Kreuzbandplastik mit proximaler Endobutton-Fixation eines Lig.-patellae-Transplantats

2- bis 5-Jahres-Ergebnisse

ACL reconstruction with bone-patellar tendon-bone graft and proximal fixation with the EndoButton:

A 2- to 5-year follow-up

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Zusammenfassung

Hintergrund

Die Verwendung von Interferenzschrauben zur Transplantatverankerung bei Rekonstruktion des vorderen Kreuzbandes (VKB) mit Lig. patellae ist eine etablierte Technik. Trotzdem besteht dabei die Gefahr einer intraoperativen Transplantatverletzung durch das Schraubengewinde und es können störende Artefakte bei postoperativen MRT-Untersuchungen und schwierige Situationen bei Revisionsoperationen auftreten. Bei gelenkferner femoraler Fixation des Transplantats mit Endobutton® werden derartige Schwierigkeiten vermieden. Ziel der Studie war eine Evaluierung der subjektiven und objektiven Ergebnisse nach VKB-Rekonstruktion mit Endobutton-Fixation.

Material und Methoden

51 Patienten (7 weiblich, 44 männlich) wurden 2–5 Jahre nach VKB-Rekonstruktion mit dem mittleren Patellarsehnendrittel und proximaler Fixation mit Endobutton nachuntersucht. Zur Auswertung wurden IKDC-Formblatt, KT-1000, Lysholm-Score, Tegner-activity-Score und digitale Röntgenaufnahmen (a.-p., lateral, axial) verwendet.

Ergebnisse

87% der in die Auswertung einbezogenen Patienten hatten das Ergebnis „normal“ oder „fast normal“ im IKDC-Score (Lysholm-Score=94,2±7,9 Punkte, Tegner-Score=6,4±1,2, subjektiver IKDC=89,9±11,9). Anhand der Röntgenaufnahmen konnten in 10 Fällen Zeichen einer leicht- oder mittelgradigen Arthrose festgestellt werden.

Schlussfolgerung

Bei vergleichbaren klinischen Ergebnissen bietet der Endobutton als Fixationsmethode entscheidende Vorteile (keine Artefakte bei Bildgebung, erleichterte Revisionseingriffe, keine Transplantatverletzung) gegenüber der Interferenzschraubenfixation und kann somit für die VKB-Rekonstruktion mit Lig. patellae empfohlen werden.

Abstract

Background

Interference screw fixation in ACL reconstruction with bone-patellar tendon-bone graft (BPTB) is a potential source of intraoperative complications such as graft laceration. Further problems are artifacts on MRI and screw removal in revision surgery. These problems can be avoided by using distant fixation with the EndoButton. We designed this study to evaluate the clinical as well as the subjective outcome of ACL reconstruction with BPTB graft and femoral fixation with the EndoButton.

Methods

A total of 51 patients (7 female, 44 male) were examined 2–5 years after ACL reconstruction with BPTB graft and femoral fixation with the EndoButton. We used the IKDC form, Lysholm score, Tegner activity score, and digital radiographs (AP, lateral, axial) for the evaluation.

Results

Of all the patients included in the study, 87% showed a “normal” or “nearly normal” knee function according to the IKDC score, Lysholm score 94.2±7.9, Tegner score 6.4±1.2, and subjective IKDC 89.9±11.9. Radiological signs of arthritic changes could be seen in ten cases.

Conclusion

The clinical outcome of ACL reconstruction with EndoButton fixation is comparable to other studies on ACL reconstruction with interference screw fixation. However, since the EndoButton avoids potential problems of the interference screw fixation, we recommend this fixation technique for ACL reconstruction with BPTB graft.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Sporttraumatologie, Universität Innsbruck, Österreich

    K. Tecklenburg, C. Hoser &  C. Fink

  2. Universitätskliniken, Innsbruck, Österreich

    R. Sailer & J. Oberladstätter

  3. Klinik für Unfallchirurgie und Sporttraumatologie, Universität, Anichstraße 35, A-6020, Innsbruck, Österreich

    C. Fink

Authors
  1. K. Tecklenburg
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  2. C. Hoser
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  3. R. Sailer
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  4. J. Oberladstätter
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  5. C. Fink
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Correspondence to C. Fink.

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Tecklenburg, K., Hoser, C., Sailer, R. et al. Vordere Kreuzbandplastik mit proximaler Endobutton-Fixation eines Lig.-patellae-Transplantats. Unfallchirurg 108, 721–727 (2005). https://doi.org/10.1007/s00113-005-0948-6

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  • DOI: https://doi.org/10.1007/s00113-005-0948-6

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