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Lösungen für häufige Komplikationen bei vorderer Kreuzbandoperation

Solutions for frequent complications of anterior cruciate ligament surgery

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Die arthroskopische vordere Kreuzbandplastik mit einem autologen Sehnentransplantat gilt heute als Standardverfahren zur Behandlung akuter und chronischer vorderer Instabilitäten. Für dieses operative Verfahren sind in großen Kollektiven Komplikationsraten zwischen 1,1 und 1,35 % beschrieben. Die häufigste Frühkomplikation nach Rekonstruktion des vorderen Kreuzbands (VKB) ist die tiefe Venenthrombose, gefolgt von der Infektion und der Lungenembolie. Ein wesentlicher Risikofaktor hierfür ist die Operationszeit. Ansätze zur Prophylaxe dieser Komplikationen sind der postoperative Einsatz niedermolekularer Heparine und das Einlegen der Transplantate in Vancomycin. Weitere Komplikationen nach VKB-Plastik sind die Arthrofibrose, die Tunnelfehlplatzierung, das Versagen des Fixationssystems, die Patellafraktur, das zu Boden gefallene Transplantat oder abgebrochene Instrumente. Auch das Risiko für diese selteneren Komplikationen lässt sich mit prophylaktischen Maßnahmen minimieren. Für die meisten beschriebenen Komplikationen sind Lösungsansätze bekannt.

Abstract

Arthroscopic anterior cruciate ligament (ACL) reconstruction with an autologous tendon graft is currently considered to be the standard procedure for the treatment of acute and chronic anterior instability. For this surgical procedure complication rates between 1.2% and 1.35% have been described in large collectives. The most common early complication after ACL reconstruction is deep vein thrombosis, followed by infections and pulmonary embolism. A major risk factor for these complications is the duration of surgery. Further approaches for prevention of these complications include the postoperative use of low molecular weight heparins and soaking the graft in vancomycin. Other complications of ACL reconstruction include arthrofibrosis, tunnel misplacement, fixation system failure, patellar fracture, transplants that have been dropped on the floor or broken instruments. The risk of these rare complications can also be minimized with prophylactic measures and solutions are known for all the described complications.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Grunewald, Caspar Theyß Straße 27–31, 14193, Berlin, Deutschland

    Wolf Petersen

  2. Sporthopaedicum Straubing, Straubing, Deutschland

    Thore Zantop

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  1. Wolf Petersen
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  2. Thore Zantop
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Correspondence to Wolf Petersen.

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Interessenkonflikt

T. Zantop und W. Petersen erhalten Beraterhonorare von der Firma Karl Storz. W. Petersen erhält Beraterhonorare von der Firma Otto Bock. W. Petersen erhält Vortragshonorare von der Firma Plasmaconceptm, AAP Implantate und dem Deutschen Institut für Zell und Gewegbetransplantation.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Petersen, W., Zantop, T. Lösungen für häufige Komplikationen bei vorderer Kreuzbandoperation. Arthroskopie 32, 308–316 (2019). https://doi.org/10.1007/s00142-019-00310-z

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