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Arthroskopische Refixation einer akuten proximalen vorderen Kreuzbandruptur mittels knotenlosem Fadenanker

Arthroscopic refixation of acute proximal anterior cruciate ligament rupture using suture anchors

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Zusammenfassung

Operationsziel

Arthroskopisch gestützte Refixation einer akuten proximalen vorderen Kreuzbandruptur zur Wiederherstellung der anatomischen und biomechanischen Integrität des vorderen Kreuzbandes (VKB).

Indikationen

Proximale VKB-Ruptur/-avulsion mit intakter Ligamentstruktur, Versorgung im Rahmen von Multiligamentverletzungen.

Kontraindikationen

Chronische proximale VKB-Ruptur (>6 Wochen), intraligamentäre VKB-Ruptur sowie Voroperationen des VKB.

Operationstechnik

Arthroskopie des Kniegelenks, Débridement der femoralen VKB-Insertionszone, Prüfen der Ligamentqualität, Fadenarmierung des VKB, Platzierung des Fadenankers zentral in der femoralen VKB-Insertion und anschließende Mikrofrakturierung.

Weiterbehandlung

Teilbelastung für insgesamt 6 postoperative Wochen. Limitation der Orthese für die ersten 2 postoperativen Wochen 0‑0-0°, anschließend 0‑0-90° für weitere 4 Wochen.

Ergebnisse

Bei 20 Patienten erfolgte die Ankerrefixation kombiniert mit einer Mikrofrakturierung bei einer akuten proximalen VKB-Ruptur. Der Nachuntersuchungszeitraum lag im Mittel bei 28 Monaten. In der klinischen Stabilitätsuntersuchung zeigten 3 Patienten einen positiven Lachman-Test Grad I und 4 Patienten einen positiven Pivot-shift-Test Grad I. Bei der KT-1000-Messung zeigte sich im Vergleich zum nichtverletzten Kniegelenk eine a.-p.-Translation von im Median 1,95 mm (±1,7). Der IKDC-Score (International Knee Documentation Committee) zeigte in 17 Fällen sehr gute bis gute (13A, 4B) und in 3 Fällen ausreichende Ergebnisse (3C). In der Magnetresonanztomographie zum Zeitpunkt der Nachuntersuchung stellte sich das VKB in 17 Fällen als intakte Kreuzbandstruktur dar. Bei insgesamt 3 Patienten erfolgte aufgrund einer Reinstabilität eine sekundäre VKB-Plastik mittels autologer Semitendinosussehne.

Abstract

Objective

Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL.

Indications

Acute proximal ACL rupture/avulsion, multiligament injury of the knee

Contraindications

Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery.

Surgical technique

Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL.

Postoperative management

Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0‑0-0°, then 0‑0-90° for the following 4 weeks.

Results

A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (<3 mm), 3 patients had a 1+ Lachman and 4 patients had a 1+ pivot shift. IKDC (International Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.

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Authors and Affiliations

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

    A. Achtnich, K. Beitzel & A. B. Imhoff

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland

    S. Rosslenbroich

  3. Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Berlin, Deutschland

    W. Petersen

Authors
  1. A. Achtnich
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  2. S. Rosslenbroich
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  3. K. Beitzel
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  4. A. B. Imhoff
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  5. W. Petersen
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Correspondence to A. Achtnich.

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Interessenkonflikt

A. Achtnich, S. Rosslenbroich und W. Petersen geben an, dass kein Interessenkonflikt besteht. K. Beitzel und A.B. Imhoff sind beratend für Arthrex tätig.

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

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Redaktion

A. B. Imhoff, München

Zeichner

R. Himmelhan, Mannheim

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Achtnich, A., Rosslenbroich, S., Beitzel, K. et al. Arthroskopische Refixation einer akuten proximalen vorderen Kreuzbandruptur mittels knotenlosem Fadenanker. Oper Orthop Traumatol 29, 173–179 (2017). https://doi.org/10.1007/s00064-016-0470-8

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  • DOI: https://doi.org/10.1007/s00064-016-0470-8

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