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Arthroskopische Rekonstruktion des vorderen Kreuzbandes in Press-fit-Technik

Arthroscopic reconstruction of anterior cruciate ligament with press-fit technique

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Zusammenfassung

Einleitung

Probleme, die bei der Verwendung von Interferenzschrauben zur Fixation des Patellarsehnentransplantats als Ersatz des vorderen Kreuzbandes (VKB) auftreten, haben zu einem zunehmenden Interesse an Press-fit-Techniken geführt. Die meisten der beschriebenen Techniken nutzen die Press-fit-Fixation nur auf der femoralen oder tibialen Seite. Deshalb wurde eine arthroskopische Technik entwickelt, welche die Press-fit-Fixation auf beiden Seiten erreicht, ohne zusätzliches Fixationsmaterial zu benötigen.

Methoden

Die ersten 40 aufeinander folgenden Patienten wurden klinisch, mit dem KT-1000 und röntgenologisch 28,7 (20–40 Monate) postoperativ nachuntersucht.

Ergebnisse

Die durchschnittliche Seit-zu-Seit-Differenz der ventralen Verschieblichkeit betrug 1,3 (SD 2,2 mm). Die Ergebnisse nach dem International-Knee-Documentation-Committee- (IKDC-)Score erbrachten 7 A, 28 B, 5 C, 0 D.

Schlussfolgerung

Die vorgestellte Press-fit-Technik vermeidet alle Probleme, die durch die Verwendung von Interferenzschrauben entstehen. Sie erreicht eine primär stabile Fixation des Patellarsehnentransplantats, wodurch eine frühfunktionelle Nachbehandlung ermöglicht wird. Trotzdem hängt die Festigkeit von der Knochenqualität ab und die arthroskopische Technik ist anspruchsvoll. Die Ergebnisse zeigen eine verlässliche Stabilisierung der operierten Knie.

Abstract

Purpose

Problems related to the use of interference screws for fixation of bone-patellar tendon-bone grafts for anterior cruciate ligament (ACL) replacement have led to increasing interest in press-fit techniques. Most of the described techniques use press-fit fixation on either the femoral or tibial side. Therefore an arthroscopic technique was developed which achieves bone-patellar tendon-bone graft fixation by press-fit on both sides without the need for supplemental fixation material.

Methods

The first consecutive 40 patients were examined clinically with a KT-1000 arthrometer and radiologically after a mean of 28.7 months (range 20–40 months) postoperatively.

Results

The mean difference in side-to-side laxity was 1.3 mm (SD 2.2 mm) and the results according to the International Knee Documentation Committee (IKDC) score were as follows: 7 A, 28 B, 5 C, 0 D.

Conclusions

The presented press-fit technique avoids all complications related to the use of interference screws. It achieves primary stable fixation of the bone-patellar tendon-bone graft thereby allowing early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding. The results showed reliable stabilization of the operated knees.

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  1. Klinik für Endoprothetik, Waldhausstr., 16766, Sommerfeld, Deutschland

    A.M. Halder

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Halder, A. Arthroskopische Rekonstruktion des vorderen Kreuzbandes in Press-fit-Technik. Unfallchirurg 113, 635–640 (2010). https://doi.org/10.1007/s00113-010-1828-2

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