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Minimal-invasive Augmentation des medialen Kollateralbandes mit autologen Hamstringsehnen bei chronischen Instabilitäten am Kniegelenk

Minimally invasive augmentation of the medial collateral ligament with autologous hamstring tendons in chronic knee instability

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Zusammenfassung

Operationsziel

Rekonstruktion der medialen Kollateralbandstrukturen zur Stabilisierung des Kniegelenks bei chronischen Instabilitäten.

Indikationen

Chronische Instabilitäten des medialen Kollateralbandes (MCL) isoliert oder kombiniert multiligamentär.

Kontraindikationen

Refixierbare knöcherne Bandausrisse, eingeschränkte Beweglichkeit, Arthrofibrose, ausgeprägte Valgusdeformität, Infektsituationen, kritische Weichteilverhältnisse, mangelnde Patientencompliance, offene Wachstumsfugen.

Operationstechnik

Entnahme der Semitendinosussehne der kontralateralen Seite und Präparation der Sehne. Rückenlagerung mit zu rekonstruierendem Bein im elektrischen Beinhalter. Schräger Hautschnitt auf Höhe des Pes anserinus parallel zu den Sehnen. Distal des tibialen Ansatzes der Hamstringsehnen Setzen eines Bohrlochs in den Ursprung des oberflächlichen MCL-Ansatzes, Einziehen des Sehnentransplantats und Fixation mittels Interferenzschraube. Subfasziale Tunnelung nach proximal, femorale Fixation des Transplantats distal des Ansatzes des medialen patellofemoralen Ligaments (MPFL) in 30° Flexion unter radiologischer Kontrolle. Tibiale Fixation des dorsalen Transplantatanteils ventral des Ansatzes der Semimembranosussehne in Extensionsstellung.

Weiterbehandlung

Teilbelastung von 20 kg für 4–6 Wochen, seitlich stabilisierende Orthesenbehandlung unter Bewegungslimitierung Extension/Flexion 0/0/90°.

Ergebnisse

Insgesamt 9 Patienten im Alter von 18–70 Jahren (Median 39 Jahre) erhielten eine Augmentation des medialen Kollateralbandkomplexes bei chronischer medialer Instabilität des Kniegelenks in der beschriebenen Technik. Die Nachuntersuchung erfolgte nach 11–56 Monaten (Median 16 Monate). Alle Patienten berichteten über ein subjektiv stabiles Kniegelenk. Der mittlere Lysholm-Score lag im Rahmen der Nachuntersuchung bei 90 (72–96) Punkten. Der Tegner-Score betrug vor dem Unfall 4 (2–6) und bei der Nachuntersuchung 3 (2–6) Punkte. Bei der Nachuntersuchung konnte keine zweit- oder drittgradige mediale Instabilität mehr festgestellt werden. Komplikationen traten im Rahmen der vorgestellten Operationstechnik nicht auf.

Abstract

Objective

Medial collateral ligament reconstruction in chronic unstable knees.

Indications

Chronic instability of the medial collateral ligament (MCL) isolated or in combination with multiligament injuries.

Contraindications

Refixable bony avulsions, limited range of motion, arthrofibrosis, severe valgus deformity, infections, critical soft tissue, lack of patient compliance and open growth plates.

Surgical technique

Harvesting of the contralateral semitendinosus tendon and preparation. Supine position with leg in electric leg holder. Oblique skin incision above the pes anserinus parallel to the tendons. Placement of drill hole distal to the tibial insertion of the hamstrings in the footprint of the MCL. Tapering and fixation of the transplant. Subfascial tunneling and femoral fixation of the transplant distally to the medial patellofemoral ligament (MPFL) origin in 30° flexion under fluoroscopic control. Tibial fixation of the dorsal portion of the transplant (POL) ventral to the semimembranosus tendon footprint in full extension.

Postoperative management

Limited weight bearing with 20 kg for 4–6 weeks, stabilizing brace with limited range of motion 0/0/90°.

Results

A total of 9 patients with a median age of 39 (18–70) years received an augmentation of the MCL complex due to a chronic instability using the described technique. Follow-up examination was performed after 16 (11–56) months. All patients reported a stable knee. The median value of the Lysholm score at follow-up was 90 (72–96) points and the Tegner score prior to trauma was 4 (2–6) points and 3 (2–6) points during follow-up. No grade 2 or 3 instability could be observed during follow-up. There were no complications using the above mentioned technique.

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Literatur

  1. Ballmer PM, Jakob RP (1988) The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg 107:273–276

    Article  PubMed  CAS  Google Scholar 

  2. Borden PS, Kantaras AT, Caborn DN (2002) Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy 18:E19

    Article  PubMed  Google Scholar 

  3. Bosworth DM (1952) Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone Joint Surg Am 34-A:196–202

    Google Scholar 

  4. Chen L, Kim PD, Ahmad CS et al (2008) Medial collateral ligament injuries of the knee: current treatment concepts. Curr Rev Musculoskelet Med 1:108–113

    Article  PubMed  Google Scholar 

  5. Derscheid GL, Garrick JG (1981) Medial collateral ligament injuries in football. Nonoperative management of grade I and grade II sprains. Am J Sports Med 9:365–368

    Article  PubMed  CAS  Google Scholar 

  6. Ellsasser JC, Reynolds FC, Omohundro JR (1974) The non-operative treatment of collateral ligament injuries of the knee in professional football players. An analysis of seventy-four injuries treated non-operatively and twenty-four injuries treated surgically. J Bone Joint Surg Am 56:1185–1190

    PubMed  CAS  Google Scholar 

  7. Frank CB, Loitz BJ, Shrive NG (1995) Injury location affects ligament healing. A morphologic and mechanical study of the healing rabbit medial collateral ligament. Acta Orthop Scand 66:455–462

    Article  PubMed  CAS  Google Scholar 

  8. Griffith CJ, Laprade RF, Johansen S et al (2009) Medial knee injury: Part 1. Static function of the individual components of the main medial knee structures. Am J Sports Med 37:1762–1770

    Article  PubMed  Google Scholar 

  9. Griffith CJ, Wijdicks CA, Laprade RF et al (2009) Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med 37:140–148

    Article  PubMed  Google Scholar 

  10. Grood ES, Noyes FR, Butler DL et al (1981) Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am 63:1257–1269

    PubMed  CAS  Google Scholar 

  11. Holden DL, Eggert AW, Butler JE (1983) The nonoperative treatment of grade I and II medial collateral ligament injuries to the knee. Am J Sports Med 11:340–344

    Article  PubMed  CAS  Google Scholar 

  12. Indelicato PA (1995) Isolated medial collateral ligament injuries in the knee. J Am Acad Orthop Surg 3:9–14

    PubMed  Google Scholar 

  13. Kannus P (1988) Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res:103–112

    Google Scholar 

  14. Kim SJ, Choi NH, Shin SJ (2001) Semitendinosus tenodesis for medial instability of the knee. Arthroscopy 17:660–663

    Article  PubMed  CAS  Google Scholar 

  15. Koga H, Muneta T, Yagishita K et al (2011) Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc §§§in press?§§§

  16. Kwak SD, Ahmad CS, Gardner TR et al (2000) Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. J Orthop Res 18:101–108

    Article  PubMed  CAS  Google Scholar 

  17. Laprade RF, Wijdicks CA (2011) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 10 (Epub ahead of print)

  18. Liu F, Yue B, Gadikota HR et al (2010) Morphology of the medial collateral ligament of the knee. J Orthop Surg Res 5:69

    Article  PubMed  Google Scholar 

  19. Lundberg M, Messner K (1996) Long-term prognosis of isolated partial medial collateral ligament ruptures. A ten-year clinical and radiographic evaluation of a prospectively observed group of patients. Am J Sports Med 24:160–163

    Article  PubMed  CAS  Google Scholar 

  20. Nakamura N, Horibe S, Toritsuka Y et al (2003) Acute grade III medial collateral ligament injury of the knee associated with anterior cruciate ligament tear. The usefulness of magnetic resonance imaging in determining a treatment regimen. Am J Sports Med 31:261–267

    PubMed  Google Scholar 

  21. Phisitkul P, James SL, Wolf BR et al (2006) MCL injuries of the knee: current concepts review. Iowa Orthop J 26:77–90

    PubMed  Google Scholar 

  22. Reider B, Sathy MR, Talkington J et al (1994) Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study. Am J Sports Med 22:470–477

    Article  PubMed  CAS  Google Scholar 

  23. Twaddle BC, Bidwell TA, Chapman JR (2003) Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 17:198–202

    Article  PubMed  Google Scholar 

  24. Van Den Bogaerde JM, Shin E, Neu CP et al (2011) The superficial medial collateral ligament reconstruction of the knee: effect of altering graft length on knee kinematics and stability. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):60–68

    Google Scholar 

  25. Wijdicks CA, Griffith CJ, Johansen S et al (2010) Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am 92:1266–1280

    Article  PubMed  Google Scholar 

  26. Wijdicks CA, Griffith CJ, Laprade RF et al (2009) Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am 91:521–529

    Article  PubMed  Google Scholar 

  27. Yoshiya S, Kuroda R, Mizuno K et al (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33:1380–1385

    Article  PubMed  Google Scholar 

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  1. Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

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

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

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Preiss, A., Giannakos, A. & Frosch, KH. Minimal-invasive Augmentation des medialen Kollateralbandes mit autologen Hamstringsehnen bei chronischen Instabilitäten am Kniegelenk. Oper Orthop Traumatol 24, 335–347 (2012). https://doi.org/10.1007/s00064-012-0164-9

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