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Komplikationen mit arthroskopischen Implantaten in der rekonstruktiven Meniskuschirurgie

Complications with all-inside devices used in reconstructive meniscal surgery

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Zusammenfassung

Die Verwendung arthroskopischer Implantate hat seit deren Einführung zu Beginn der 1990er Jahre einen festen Platz in der rekonstruktiven Meniskuschirurgie gefunden. Auch wenn neuere klinische Studien die Überlegenheit der konventionellen arthroskopisch assistierten Nahttechniken zeigen, stellen die intraartikulär einzubringenden Implantate wegen ihrer geringen Zugangsmorbidität und ihrer einfachen Handhabung eine wichtige Alternative zur Behandlung von Meniskusrissen dar.

Im Laufe der Zeit haben sich die Berichte über spezifische Komplikationen im Zusammenhang mit Meniskusimplantaten multipliziert. Insbesondere Knorpelschäden, Implantatlockerungen und -wanderungen sowie Kapsel- und Nervenirritationen werden vielfach beschrieben. Des Weiteren schildern einige Autoren Fremdkörperreaktionen, Granulom- und Zystenbildungen nach Verwendung von Implantaten. Erhöhte Infektionsraten oder spezifische Infektionen mit intraartikulären Implantaten wurden hingegen nicht beobachtet.

Die klinischen Komplikationsberichte sowie die biomechanischen Studien zu Meniskusimplantaten haben zur Modifikation bekannter Produkte und zur Neuentwicklung von Implantaten geführt. Die Zahl spezifischer Zwischenfälle scheint, zumindest nach Durchsicht der neuren Literatur, rückläufig zu sein. Intraartikuläre Implantate stellen in vielerlei Hinsicht eine interessante Alternative zu den bewährten Nahttechniken dar.

Abstract

All-inside devices have become increasingly popular in reconstructive meniscal surgery since their introduction at the beginning of the 1990s. Although the latest clinical investigations show better results for conventional suture techniques, meniscal devices are an important alternative because of the low risk of neurovascular injury and the easy handling of the instruments.

Over the years, many reports on specific complications related to all-inside devices have been published. Especially chondral injuries, implant loosening, device migration and capsular or neural irritations have been described. Furthermore, some authors reported on foreign body reactions and cystic granulomas after the use of meniscal fixation devices. However, there is no evidence for a higher infection rate or for specific infections after the use of intra-articular techniques.

Clinical reports on complications along with biomechanical studies on meniscal repair devices have led to the enhancement of all-inside techniques through substantial modifications of established products as well as to the development of new implants. After reviewing the latest literature, the complication rate seems to be decreasing. In many ways, all-inside devices are an interesting alternative to conventional suture techniques. A precise knowledge of their potential complications and the pitfalls during surgery however is crucial to make a risk evaluation in the choice of the right technique for meniscal reconstruction.

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  1. Service d’Orthopédie et de Traumatologie, Centre de l’Appareil Locomoteur, de Médecine du Sport et de Prévention, Centre Hospitalier de Luxembourg - Clinique d’Eich, 4, Rue Barblé, 1210, Luxembourg, Luxembourg

    P. Wilmes, O. Lorbach, P. Brogard & R. Seil

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  1. P. Wilmes
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  2. O. Lorbach
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  3. P. Brogard
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Wilmes, P., Lorbach, O., Brogard, P. et al. Komplikationen mit arthroskopischen Implantaten in der rekonstruktiven Meniskuschirurgie. Orthopäde 37, 1088–1098 (2008). https://doi.org/10.1007/s00132-008-1307-4

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