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Tunnelauffüllung bei zweizeitiger Revision am vorderen Kreuzband

Operationstechnik

Tunnel filling in two-stage revision on the anterior cruciate ligament

Surgical technique

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Einleitung

Die Indikation zur Revision einer Ersatzplastik des vorderen Kreuzbands (VKB) kann neben einer Reruptur des Transplantats auch durch eine chronische Instabilität oder eine eingeschränkte Kniegelenkbeweglichkeit gegeben sein. Eine genaue Ursachenanalyse ist in allen Fällen unumgänglich.

Material und Methoden

Neben Anamnese und klinischer Untersuchung erfolgt eine konventionell radiologische Standarddiagnostik sowie eine Computertomographie (CT) zur Beurteilung der primären Bohrkanallage und -weite. Vor allem die partiell anatomische Tunnelposition und/oder eine Tunnelweitung >15 mm prädisponieren für ein zweizeitiges Vorgehen. Im Rahmen einer ersten Operation erfolgt ein arthroskopisches Débridement der Bohrkanäle mit anschließender knöcherner Auffüllung mittels autologem Knochenmaterial (z. B. Beckenkammspongiosa) oder Knochenersatzmaterialen. Im Durchschnitt erfolgt nach 3 bis 6 Monaten eine erneute CT-Diagnostik zur Beurteilung der Integration des implantierten Knochens. Anschließend kann die erneute VKB-Ersatzplastik im Rahmen einer zweiten Operation durchgeführt werden.

Ergebnisse und Schlussfolgerung

In der aktuellen Literatur zeigen klinische Studien nach VKB-Revision im Vergleich mit der primären VKB-Ersatzplastik insgesamt signifikant schlechtere Ergebnisse. Insbesondere Studien bzw. Ergebnisse nach zweizeitiger VKB-Revision sind sehr rar und lassen keine evidenten Schlüsse ziehen; entsprechend sind hier weitere Studien notwendig.

Abstract

Introduction

Indications for revision surgery of the anterior cruciate ligament (ACL) may result from ACL re-rupture, persistent or increasing instability or limited range of motion of the knee joint. A comprehensive analysis of possible causes of failure is absolutely essential in all cases.

Material and methods

Besides the medical history and a clinical examination, conventional radiographs and computed tomography (CT) are necessary for evaluation of the position and the width of the primary bone tunnels. Partial anatomic tunnel placement and/or tunnel widening >15 mm, in particular, require a two-stage surgical procedure. In a first arthroscopic operation an arthroscopic debridement of the primary tunnels is carried out and subsequent filling with autologous bone material (e. g. from the iliac crest) or by synthetic bone substitutes. After a mean of 3–6 months a further CT scan is performed to evaluate the integration of the implanted bone. Afterwards a new ACL reconstruction can be performed in a second operation.

Results and conclusion

According to the current literature ACL revision surgery in general shows significantly poorer clinical results in comparison to primary ACL reconstruction. Regarding the two-stage procedure in particular only few data are available, which do not allow any obvious conclusions to be drawn; therefore further studies are necessary.

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Literatur

  1. Achtnich A, Feucht MJ, Hinterwimmer S et al (2017) Bänder. In: Imhoff AB, Feucht MJ (Hrsg) Atlas sportorthopädisch-sporttraumatologische Operationen. Springer, Deutschland, S 281–331

    Chapter  Google Scholar 

  2. Achtnich A, Ranuccio F, Willinger L et al (2017) High incidence of partially anatomic tunnel placement in primary single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4555-1

    Article  PubMed  Google Scholar 

  3. Chen JL, Allen CR, Stephens TE et al (2013) Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: a MARS cohort study. Am J Sports Med 41(7):1571–1578. https://doi.org/10.1177/0363546513487980

    Article  PubMed  Google Scholar 

  4. Erickson BJ, Cvetanovich G, Waliullah K et al (2016) Two-stage revision anterior cruciate ligament reconstruction. Orthopedics 39:e456–e464. https://doi.org/10.3928/01477447-20160324-01

    Article  PubMed  Google Scholar 

  5. Franceschi F, Papalia R, Del Buono A et al (2013) Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study. Int Orthop 37:1369–1374. https://doi.org/10.1007/s00264-013-1886-5

    Article  PubMed  PubMed Central  Google Scholar 

  6. Grassi A, Ardern CL, Marcheggiani Muccioli GM et al (2016) Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results. Br J Sports Med 50:716–724. https://doi.org/10.1136/bjsports-2015-094948

    Article  PubMed  Google Scholar 

  7. Grote S, Helfen T, Muck F et al (2015) Femoral marrow cavity bone harvesting used for arthroscopic refilling of misplaced or enlarged bone tunnels in revision ACL surgery: an arthroscopically supported technique with antegrade intramedullary bone harvesting by a reamer-irrigator-aspirator (RIA) system. Knee Surg Sports Traumatol Arthrosc 23:808–815. https://doi.org/10.1007/s00167-013-2736-0

    Article  PubMed  CAS  Google Scholar 

  8. Kvist J, Kartus J, Karlsson J et al (2014) Results from the Swedish national anterior cruciate ligament register. Arthroscopy 30:803–810. https://doi.org/10.1016/j.arthro.2014.02.036

    Article  PubMed  Google Scholar 

  9. Marchant BG, Noyes FR, Barber-Westin SD et al (2010) Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. Am J Sports Med 38:1987–1996. https://doi.org/10.1177/0363546510372797

    Article  PubMed  Google Scholar 

  10. Marquass B, Engel T, Hepp P et al (2007) One- and two-stage procedure for revision after failure of anterior cruciate ligament reconstruction. Z Orthop Unfall 145:712–718

    Article  PubMed  CAS  Google Scholar 

  11. Mayr HO, Willkomm D, Stoehr A et al (2012) Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2‑ and 5‑year results. Arch Orthop Trauma Surg 132:867–874. https://doi.org/10.1007/s00402-012-1481-z

    Article  PubMed  Google Scholar 

  12. Mayr R, Rosenberger R, Agraharam D et al (2012) Revision anterior cruciate ligament reconstruction: an update. Arch Orthop Trauma Surg 132:1299–1313. https://doi.org/10.1007/s00402-012-1552-1

    Article  PubMed  CAS  Google Scholar 

  13. Morgan JA, Dahm D, Levy B et al (2012) Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg 25:361–368. https://doi.org/10.1055/s-0031-1299662

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sanders TL, Pareek A, Hewett TE et al (2017) Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc 25:222–228. https://doi.org/10.1007/s00167-016-4275-y

    Article  PubMed  Google Scholar 

  15. Shino K, Mae T, Nakamura N (2012) Surgical technique: revision ACL reconstruction with a rectangular tunnel technique. Clin Orthop Relat Res 470:843–852. https://doi.org/10.1007/s11999-011-1948-1

    Article  PubMed  Google Scholar 

  16. Thomas NP, Kankate R, Wandless F et al (2005) Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Am J Sports Med 33:1701–1709

    Article  PubMed  Google Scholar 

  17. Tomihara T, Hashimoto Y, Taniuchi M et al (2017) One-stage revision ACL reconstruction after primary ACL double bundle reconstruction: is bone-patella tendon-bone autograft reliable? Knee Surg Sports Traumatol Arthrosc 25:1653–1661. https://doi.org/10.1007/s00167-017-4483-0

    Article  PubMed  Google Scholar 

  18. Uchida R, Toritsuka Y, Mae T et al (2016) Healing of tibial bone tunnels after bone grafting for staged revision anterior cruciate ligament surgery: a prospective computed tomography analysis. Knee 23:830–836. https://doi.org/10.1016/j.knee.2016.04.012

    Article  PubMed  Google Scholar 

  19. Weber AE, Delos D, Oltean HN et al (2015) Tibial and femoral tunnel changes after ACL reconstruction: a prospective 2‑year longitudinal MRI study. Am J Sports Med 43:1147–1156. https://doi.org/10.1177/0363546515570461

    Article  PubMed  Google Scholar 

  20. Wright RW, Gill CS, Chen L et al (2012) Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 94:531–536. https://doi.org/10.2106/JBJS.K.00733

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zantop T, Petersen W (2011) Arthroscopic filling of misplaced and wide bone tunnels after reconstruction of the anterior cruciate ligament with bone graft in patients with recurrent instability. Oper Orthop Traumatol 23(4):337–350. https://doi.org/10.1007/s00064-011-0029-7

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland

    J. Mehl, A. B. Imhoff & A. Achtnich

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  1. J. Mehl
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  2. A. B. Imhoff
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  3. A. Achtnich
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Correspondence to J. Mehl.

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J. Mehl, A.B. Imhoff und A. Achtnich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Mehl, J., Imhoff, A.B. & Achtnich, A. Tunnelauffüllung bei zweizeitiger Revision am vorderen Kreuzband. Arthroskopie 31, 252–256 (2018). https://doi.org/10.1007/s00142-017-0178-2

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