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Anatomische Doppelbündelrekonstruktion mit autologer Semitendinosussehne

Anatomic double bundle reconstruction using semitendinosus tendon graft

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Einleitung

Das Kontinuum der Fasern des vorderen Kreuzbands (VKB) wirkt als synergistische Zweibündelstruktur. Ziel der anatomischen VKB-Doppelbündelrekonstruktion ist es, die Hauptbündel mit Hilfe von separaten Transplantaten wiederherzustellen und somit die komplexen Stabilisierungsaufgaben des VKB zu imitieren.

Operationstechnik

Die Transplantatentnahme der Semitendinosussehne erfolgt mit Ablösung der Sehne im Bereich der Tuberositas tibiae (Optimierung der Transplantatlänge). Das anteromediale (AM) Bündel wird in medialer Portaltechnik mit einem Doppelbündelzielgerät in Flexion von etwa 110° lokalisiert. Nach Kontrolle der Probebohrung mittels medialer Portalvisualisation wird der K-Draht mit einem 4,5-mm-Bohrer überbohrt. Die posterolaterale (PL) Bündelplatzierung erfolgt individuell mit einem PL-Bündel-Zielgerät, das auf die Insertions- und Transplantatgröße abgestimmt wird. Auch hier wird zunächst eine bikortikale 4,5-mm-Bohrung durchgeführt und die AM- und PL-Sacklochbohrung an die Längenbestimmung angepasst. Tibial wird das AM-Bündel im VKB-Stumpf auf Höhe des Außenmeniskusvorderhorns platziert. Mit einem tibialen DB-Zielgerät wird das PL-Bündel etwa 8–10 mm posterior vom Zentrum des AM-Bündels lokalisiert. Der Transplantateinzug erfolgt in medialer Portalvisualisation. Nach femoraler Fixation über einen extrakortikalen Kippanker wird das zunächst das PL-Bündel in etwa 10° Knieflexion und das AM-Bündel in 45° Flexion in Hybridtechnik mittels bioresorbierbarer Interferenzschraube und tibialem Button fixiert.

Diskussion

Die anatomische VKB-Doppelbündelrekonstruktion mit autologer Semitendinosussehne ist eine wichtige Operationstechnik im Konzept der anatomischen VKB-Rekonstruktion. Bei großen Insertionsarealen und hohem Aktivitätsniveau des Patienten kann sie die Rotations- und anteriore Instabilität reduzieren.

Abstract

Introduction

Fibres of the anterior cruciate ligament (ACL) can be distinguished into two functional bundles. The aim of an anatomic double bundle ACL reconstruction is to replicate these two bundles and their function using two separate femoral and two separate tibial tunnels.

Surgical technique

Graft harvesting is performed with a preparation of the semitendinosus tendon to its insertion at the tibial tuberosity thereby increasing graft length. The anteromedial (AM) bundle is located in a medial portal approach using a specific double bundle aimer in 110° flexion. First, a k-wire is predrilled, controlled via medial portal visualization and subsequently overdrilled using a bicortical 4.5 mm drill. The posterolateral (PL) bundle is located using a PL bundle aimer with individual distance and with respect to the anatomic insertion size and graft diameter. The PL bundle is first predrilled and after visualization via the medial portal overdrilled (4.5 mm). Graft size tunnels are drilled in accordance to the bicortical length. The tibial AM bundle is located with respect to the anterior horn of the lateral meniscus and the center of the PL bundle approximately 8–10 mm posterior to the AM k-wire. After femoral fixation of the graft passage with a cortical flip button the PL bundle is fixed in 10° knee flexion and the AM bundle in 45° flexion using medial portal visualization and tibial fixation in a hybrid technique.

Discussion

Anatomic double bundle ACL reconstruction is an important part of the concept of anatomic ACL reconstruction. In appropriate sized insertion areas and highly active patients this reconstruction can be beneficial limiting anterior and rotational instability.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: Karl Storz, Tuttlingen, beratende Tätigkeit.

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Authors and Affiliations

  1. Sporthopaedicum Straubing, Bahnhofsplatz 27, 94315, Straubing, Deutschland

    T. Zantop

  2. Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Deutschland

    W. Petersen

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  1. T. Zantop
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  2. W. Petersen
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Correspondence to T. Zantop.

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Zantop, T., Petersen, W. Anatomische Doppelbündelrekonstruktion mit autologer Semitendinosussehne. Arthroskopie 26, 21–34 (2013). https://doi.org/10.1007/s00142-012-0714-z

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  • DOI: https://doi.org/10.1007/s00142-012-0714-z

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