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Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes

Klinische und funktionelle Ergebnisse nach Einzelbündel- und Doppelbündelrekonstruktion

Comparable results after arthroscopic replacement of the anterior cruciate ligament

Clinical and functional results after single bundle and double bundle reconstruction

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Zusammenfassung

Einleitung

Die Ruptur des vorderen Kreuzbandes (VKB) wird seit vielen Jahren operativ überwiegend arthroskopisch rekonstruiert. Dem lange propagierten Einzelbündelersatz folgten Empfehlungen zur anatomischen Doppelbündelersatzplastik. Ziel dieser Studie ist die Auswertung und Beurteilung klinischer Nachuntersuchungsergebnisse hinsichtlich Funktion und Stabilität nach Durchführung einer VKB-Plastik sowohl mit der Einzelbündel(SB)- als auch der Doppelbündel(DB)-Technik.

Methodik

80 Patienten, die eine VKB-Plastik erhielten, wurden eingeschlossen (41 SB / 39 DB). Der Nachuntersuchungszeitraum betrug 17,4 Monate. Zur Beurteilung der Kniegelenksstabilität wurden die anteroposteriore Translation sowie die Rotationstranslation ermittelt. Zudem erfolgten die arthrometrische Messung sowie die Durchführung standardisierter Scores. Die Daten wurden mittels Pearson‑χ2-Test und dem exakten Test nach Fischer statistisch ausgewertet (p < 0,05).

Ergebnisse

Während der Lachman-Test in der SB-Gruppe eine signifikant (p = 0,032) größere Stabilität der Kniegelenke zeigte, wurde durch den vorderen Schubladentest und die Stabilitätsmessung mit dem Rolimeter eine höhere Stabilität der Kniegelenke in der DB-Gruppe dokumentiert. In der DB-Gruppe zeigten sich eine signifikant höhere Anzahl an Patienten mit lokalen Sensibilitätsdefiziten (p = 0,045) und Parästhesien sowie ein signifikant höheres aktives und passives Flexionsdefizit gegenüber der SB-Gruppe (p = 0,09/p = 0,038).

Fazit

Basierend auf den Ergebnissen zeigt unsere Studie nach einem Nachuntersuchungszeitraum von mindestens 12 Monaten keine Überlegenheit eines Verfahrens, jedoch gibt es Hinweise für eine höhere Komplikationsrate in der DB-Gruppe. Klinisch sollten diese Ergebnisse bei der Indikationsstellung bedacht werden.

Abstract

Introduction

Rupture of the anterior cruciate ligament (ACL) has been surgically reconstructed mainly arthroscopically for many years. The long-propagated single bundle replacement was followed by recommendations for the anatomical double-bundle reconstruction. The aim of this study is the evaluation of clinical follow-up results in terms of function and stability after performing an ACL reconstruction with both the single bundle (SB) and the double bundle (DB) technique.

Methodology

Eighty patients receiving ACL reconstruction were included (41 SB / 39 DB). The follow-up period was 17.4 months. To assess knee joint stability, anteroposterior translation and rotation translation were determined. In addition, arthrometric measurement and the implementation of standardized scores were performed. Data were statistically evaluated using the Pearson χ2 test and Fisher’s exact test (p = 0.05).

Results

While the Lachman test in the SB group showed a significant (p = 0.032) greater stability of the knee joints, a higher stability of the knee joints in the DB group was documented by the anterior drawer test and the stability measurement with the rolimeter. In the DB group a significantly higher number of patients with local sensitivity deficits (p = 0.045) and paresthesia as well as a significantly higher active and passive flexion deficit were noted compared to the SB group (p = 0.09 / p = 0.038, respectively).

Conclusion

Based on the results of this study it is currently not possible to give any recommendations regarding any operating procedure after a follow-up period of at least 12 months. However, there is evidence of a higher complication rate in the DB group. Clinically, these results should be considered in the evaluation of the indications.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    M. Janko, R. D. Verboket MHBA, E. Plawetzki,  E. V. Geiger,  T. Lustenberger,  I. Marzi &  C. Nau

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  1. M. Janko
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Correspondence to M. Janko.

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Interessenkonflikt

M. Janko, R. D. Verboket, E. Plawetzki, E.V. Geiger, T. Lustenberger, I. Marzi und C. Nau geben an, dass kein Interessenkonflikt besteht.

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. Diese retrospektive Studie erfolgte nach Konsultation der zuständigen Ethikkommission und im Einklang mit nationalem Recht.

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Die Autoren M. Janko und R. D. Verboket haben zu gleichen Teilen zu der Arbeit beigetragen.

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Janko, M., Verboket, R.D., Plawetzki, E. et al. Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes. Chirurg 91, 67–75 (2020). https://doi.org/10.1007/s00104-019-01050-4

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