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Probleme und Komplikationen nach vorderer Kreuzbandplastik im Wachstumsalter

Problems and complications after anterior cruciate ligament repair in immature patients

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Hintergrund

In einer eigenen systematischen Literaturanalyse zur Behandlung der vorderen Kreuzbandruptur im Wachstumsalter konnten wir zeigen, dass das klinische Ergebnis nach konservativer Therapie unbefriedigend ist. Dies wird v. a. durch eine persistierende Instabilität mit einem positiven Giving-way-Phänomen in etwa 89% der Fälle begründet.

Methoden

Die operative Versorgung der vorderen Kreuzbandruptur im Wachstumsalter führt i. d. R. zu guten klinischen Ergebnissen. Unter Beachtung aktueller Empfehlungen bei der operativen Versorgung können Wachstumsstörungen weitgehend vermieden werden. Aufgrund der Anwendung einer aus der Erwachsenenchirurgie bekannten Operationstechnik sowie der Unkenntnis über kindgerechte Operationstechniken werden jedoch zunehmend Komplikationen nach operativer Versorgung der vorderen Kreuzbandruptur beobachtet.

Ergebnisse

Zu den häufigsten postoperativen Wachstumsstörungen gehören Beinlängendifferenzen, Genu valgum, Genu varum oder das Genu recurvatum. Isolierte Beinlängendifferenzen sind durch die operative Technik schwer zu vermeiden und werden wahrscheinlich durch die Stimulation der Wachstumsfuge mittels chirurgischer Manipulationen hervorgerufen. Eine Beinverkürzung kann durch einen Tenoepiphysiodese-Effekt des Transplantats verursacht werden. Achsenabweichungen und Fehlstellungen entstehen i. d. R. durch randständige Fugenverletzungen der Bohrkanäle. Implantate oder Knochenblöcke auf Höhe der Fugen sowie nicht mit Sehnengewebe gefüllte Bohrkanäle auf Fugenhöhe können weitere Ursachen für die Entstehung von Fehlwachstum darstellen.

Schlussfolgerung

Im dem vorliegenden Artikel sollen diese Probleme und Komplikationen nach vorderer Kreuzbandplastik im Wachstumsalter dargestellt und Vermeidungsstrategien vorgestellt werden, um das Risiko intra- und postoperativer Komplikationen zu minimieren.

Abstract

Background

In a systematic literature analysis on the treatment of anterior cruciate ligament rupture in immature patients it could be shown that the clinical results of conservative therapy are unsatisfactory. In particular this is reflected by persisting instability with a positive giving way phenomenon in approximately 89 % of cases.

Methods

The operative treatment of anterior cruciate ligament rupture in the growth stage as a rule leads to good clinical results. By complying with current recommendations for operative treatment growth disturbances can be largely avoided. However, by the use of recognized operational techniques for adults and non-recognition of operational techniques suitable for children, complications are increasingly observed following operative treatment of anterior cruciate ligament ruptures.

Results

The most common postoperative growth disorders are differences in leg length, genu valgum, genu varum and genu recurvatum. Isolated leg length differences are difficult to avoid due to the operative technique and are probably provoked by stimulation of the epiphyses by surgical manipulation. Leg shortening can be caused by a teno-epiphysiodesis effect of the transplant. Axial deviations and bad posture are as a rule caused by peripheral epiphysial damage of the bore canal. Implants or bone blocks at the level of the growth plate as well as drill channels not filled with tendonous tissue at the level of the growth plate can be further causes of growth disorders.

Conclusion

This article demonstrates the problems and complications after anterior cruciate ligament repair in immature patients and avoidance strategies are presented in order to minimize intraoperative and postoperative complications.

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Authors and Affiliations

  1. Chirurgisch-Traumatologisches Zentrum, Unfall- und Wiederherstellungschirurgie mit BG-Abteilung des BUKH, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    K.-H. Frosch, A. Preiss & A. Giannakos

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  1. K.-H. Frosch
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  2. A. Preiss
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  3. A. Giannakos
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Correspondence to K.-H. Frosch.

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Frosch, KH., Preiss, A. & Giannakos, A. Probleme und Komplikationen nach vorderer Kreuzbandplastik im Wachstumsalter. Arthroskopie 25, 260–265 (2012). https://doi.org/10.1007/s00142-011-0690-8

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  • DOI: https://doi.org/10.1007/s00142-011-0690-8

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