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Arthroskopisch assistierter simultaner vorderer und hinterer Kreuzbandersatz

Arthroscopically-assisted combined anterior and posterior cruciate ligament reconstruction

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Zusammenfassung

Hintergrund

Die beste Behandlungsstrategie der seltenen, kombinierten vorderen und hinteren Kreuzbandrupturen ist noch ungeklärt.

Methoden

Von 2001–2003 wurden 9 Patienten mit einer einseitigen, traumatischen vorderen und hinteren Kreuzbandruptur operativ behandelt. Der arthroskopische simultane Kreuzbandersatz erfolgte 235 (52–567) Tage nach dem Trauma mit ipsilateralem Patellarsehnen- und Hamstringsehnentransplantat. In einer retrospektiven Kohortenstudie konnten alle Patienten 37 (24–58) Monate postoperativ nachuntersucht werden.

Ergebnisse

Die Patienten erreichten bei der Nachuntersuchung (NU) im Lysholm-Score durchschnittlich 74 Punkte. Im IKDC-Score erreichten 4 Patienten die Gruppe B und 5 Patienten die Gruppe C. Der Aktivitätsscore nach Tegner stieg von 1,9 vor dem Unfall auf 5,0 zur NU, wobei sich alle Patienten um 1–5 Aktivitätslevel verbesserten. Die Messung der Kniestabilität und isokinetischen Muskelkraft ergab im Vergleich zur gesunden Gegenseite signifikant schlechtere Ergebnisse. Es zeigte sich eine wesentliche Einschränkung der Lebensqualität vor allem in Bezug auf die körperliche Befindlichkeit.

Schlussfolgerung

Die Patienten kamen nach arthroskopisch assistierter, simultaner vorderer und hinterer Kreuzbandersatzplastik im Alltag gut zurecht. Das vorherige sportliche Niveau konnte keiner der Patienten wieder erreichen.

Abstract

Background

The best treatment of a combined rupture of the anterior and posterior cruciate ligaments is still unclear.

Methods

Nine patients with unilateral traumatic ruptures of both the anterior and posterior cruciate ligaments were treated by arthroscopically-assisted simultaneous reconstruction. The operation was done using hamstring tendon and patellar tendon autografts, an average of 235 days (range 52–567) after the initial trauma. Patients were followed up for an average of 37 months (range 24–58) after surgery. For this retrospective cohort study, we used the Lysholm knee score, the Tegner activity score, and the SF-36 questionnaire as a means of assessment.

Results

The evaluation at follow-up showed an average score of 74 points on the Lysholm scale. Using the IKDC evaluation, four patients could be placed in group B and five patients in group C. A significant increase, from 1.9 points before trauma to 5.0 points at follow-up, was observed on the Tegner activity score. Comparing the operated with the healthy knees, with respect to stability and isokinetic muscle strength, we noted significantly better scores in the healthy knees. Using the SF-36 questionnaire, patients showed a reduced level of physical well-being.

Conclusion

The treated patients were able to carry out their activities of everyday life. However, none of them returned to their preinjury activity level.

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Authors and Affiliations

  1. Klinik für Orthopädie und Rheumatologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland

    M.D. Schofer, C.D. Peterlein & S. Fuchs-Winkelmann

  2. Berufsgenossenschaftliche Unfallklinik Duisburg GbR, Duisburg, Deutschland

    H.R. Kortmann

Authors
  1. M.D. Schofer
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  2. C.D. Peterlein
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  3. S. Fuchs-Winkelmann
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  4. H.R. Kortmann
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Correspondence to M.D. Schofer.

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Schofer, M., Peterlein, C., Fuchs-Winkelmann, S. et al. Arthroskopisch assistierter simultaner vorderer und hinterer Kreuzbandersatz. Unfallchirurg 111, 703–710 (2008). https://doi.org/10.1007/s00113-008-1468-y

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  • DOI: https://doi.org/10.1007/s00113-008-1468-y

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