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Akute Verletzung des hinteren Kreuzbandes mit femoraler Avulsion

Banderhaltende arthroskopische Refixation und Bracing

Acute injury of the posterior cruciate ligament with femoral avulsion

Arthroscopic ligament repair and bracing

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Wiederherstellung der anatomischen und biomechanischen Eigenschaften des hinteren Kreuzbandes (HKB) in der Akutsituation. Hierbei erfolgt die arthroskopisch gestützte Reinsertion des HKB durch Auszugsnähte kombiniert mit einem „Ligament Bracing“ zur Erhöhung der Primärstabilität und zum Erhalt der propriozeptiven Funktion.

Indikationen

Akute Verletzungen des HKB mit femoraler Avulsion, isoliert oder im Rahmen von Multiligamentverletzungen.

Kontraindikationen

Chronische Instabilitäten des HKB, Gelenkinfektionen.

Operationstechnik

Arthroskopische Präparation der femoralen HKB-Insertion. Anschlingen der intakten HKB-Struktur mit nichtresorbierbarem Fadenmaterial mittels Fadenzange oder Lassosystem. Platzieren der Bohrkanäle für das „Ligament Bracing“ mit Hilfe arthroskopischer Zielgeräte femoral und tibial. Fixation des Fadenaugmentationssystems und der vorgelegten Anschlingfäden femoral extrakortikal über einen Button oder intraartikulär mit einem Anker. Abschließend tibiale Fixation über einen Button in mindestens 80°-Flexion bei permanentem vorderem Schubladenstress.

Weiterbehandlung

Streckorthese mit tibialem posteriorem Support 24 h/Tag sowie Teilbelastung von 20 kg für 6 Wochen. Physiotherapeutische Beübung in Bauchlage, ROM („range of motion“) bis max. 0‑0-90°. Ab der 7. postoperativen Woche Belastungsaufbau, Steigerung der Beweglichkeit und Tragen einer Hartrahmenorthese mit posteriorem Support für weitere 6 Wochen.

Abstract

Objective

The aim of arthroscopic bracing of the posterior cruciate ligament (PCL) is to restore anatomic and biomechanic function in acute PCL tears. Therefore, primary augmentation of the PCL by using a stable suturing system is used.

Indications

Acute tears of the PCL, femoral avulsions, isolated or combined in cases of multiligament injuries (knee dislocations of Schenk types II–IV).

Contraindications

Chronic instabilities of the PCL, infection of the knee joint.

Surgical technique

Arthroscopic preparation of the femoral PCL footprint. Suturing of the PCL stump with non-resorbable sutures. Placement of the femoral and tibial tunnel with a specific arthroscopic PCL guide. Femoral fixation of the bracing system and the PCL augmenting sutures extracortical via a button or intraarticular with a suture anchor. Tibial fixation via a button has to be performed in a minimum of 80° of flexion and under permanent anterior drawer tension.

Postoperative management

Brace in full extension with posterior support 24 h/day, range of motion (ROM) restricted up to 90° of flexion and limited weight bearing with 20 kg for the first 6 weeks postoperatively. After 6 weeks, weight bearing and ROM can be increased and a solid frame brace with posterior support is recommended for the next 6 weeks.

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Literatur

  1. Bedi A, Musahl V, Cowan JB (2016) Management of posterior cruciate ligament injuries: an evidence-based review. J Am Acad Orthop Surg 24:277–289

    Article  Google Scholar 

  2. Flint JH, Wade AM, Giuliani J et al (2014) Defining the terms of acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 42:235–241

    Article  Google Scholar 

  3. Fox JM, Sherman OH, Markolf K (1985) Arthroscopic anterior cruciate ligament repair: preliminary results and instrumented testing for anterior stability. Arthroscopy 1:175–181

    Article  CAS  Google Scholar 

  4. Heitmann M, Gerau M, Hötzel J et al (2014) Ligament bracing – augmented primary suture repair in multiligamentous knee injuries. Oper Orthop Traumatol 26(1):19–29

    Article  CAS  Google Scholar 

  5. Heitmann M, Drazidis A, Jagodzinski M et al (2014) Ligament bracing – augmented cruciate ligament sutures: biomechanical studies of a new treatment concept. Unfallchirurg 117(7):650–657

    Article  CAS  Google Scholar 

  6. Howells NR, Brunton LR, Robinson J et al (2011) Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury 42:1198–1204

    Article  Google Scholar 

  7. Kim SJ, Shin SJ, Choi NH et al (2001) Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am 83-A:698–708

    Article  CAS  Google Scholar 

  8. Levy BA, Dajani KA, Whelan DB et al (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25:430–438

    Article  Google Scholar 

  9. Levy BA, Fanelli GC, Whelan DB et al (2009) Controversities in the treatment of knee dislocations and multiligament reconstrucitons. J Am Acad Orthop Surg 17:197–206

    Article  Google Scholar 

  10. Liow RY, McNicholas MU, Keating JF et al (2003) Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 85:845–851

    Article  CAS  Google Scholar 

  11. Mariani PP, Santoriello P, Iannone S et al (1999) Comparison of surgical treatments for knee dislocation. Am J Knee Surg 12:92–96

    Google Scholar 

  12. Owens SB, Neault M, Benson E et al (2007) Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma 21:92–96

    Article  Google Scholar 

  13. Rihn JA, Groff YJ, Harner CD, Cha PS (2004) The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 12:334–346

    Article  Google Scholar 

  14. Hughston JC, Bowden JA, Andrews JR, Norwood LA (1980) Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg Am 62:438–450

    Article  CAS  Google Scholar 

  15. Strand T, Molster AO, Engesaeter LB et al (1984) Primary repair in posterior cruciate ligament injuries. Acta Orthop Scan 55(5):545. https://doi.org/10.3109/17453678408992956

    Article  CAS  Google Scholar 

  16. Pournaras J, Symeonides PP (1991) The results of surgical repair of acute tears of the posterior cruciate ligament. Clin Orthop Relat Res 267:103–107

    Google Scholar 

  17. Richter M, Bosch U, Wippermann B et al (2002) Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 30(5):718–727

    Article  Google Scholar 

  18. Wheatley WB, Martinez AE, Sacks T et al (2002) Arthroscopic posterior cruciate ligament repair. Arthroscopy 7:695–702

    Article  Google Scholar 

  19. Van der List JP, DiFelice G (2017) Arthroscopic primary posterior cruciate ligament repair with suture augmentation. Arthroscopy 5:1685–1690

    Article  Google Scholar 

  20. Achtnich A (2017) HKB-Ersatzplastik. In: Imhoff AB, Feucht MJ (Hrsg) Atlas sportorthopädisch-sporttraumatologische Operationen. Springer, Berlin, Heidelberg, S 312–319

    Google Scholar 

  21. Achtnich A (2017) Arthroskopisches „Ligament Bracing“ bei akuten multiligamentären Verletzungen. In: Imhoff AB, Feucht MJ (Hrsg) Atlas sportorthopädisch-sporttraumatologische Operationen. Springer, Berlin, Heidelberg, S 328–330

    Google Scholar 

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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, A. Schmitt, P. Forkel, A. B Imhoff & K. Beitzel

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  1. A. Achtnich
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  2. A. Schmitt
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  3. P. Forkel
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  4. A. B Imhoff
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Correspondence to A. Achtnich.

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Interessenkonflikt

A. Achtnich, A. Schmitt, P. Forkel, A.B. Imhoff und K. Beitzel geben an, dass kein Interessenkonflikt besteht.

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

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M. Hessmann, Fulda

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R. Himmelhan, Mannheim

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Achtnich, A., Schmitt, A., Forkel, P. et al. Akute Verletzung des hinteren Kreuzbandes mit femoraler Avulsion. Oper Orthop Traumatol 31, 12–19 (2019). https://doi.org/10.1007/s00064-018-0578-0

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  • DOI: https://doi.org/10.1007/s00064-018-0578-0

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