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Weichteilmanagement bei der Varusgonarthrose

Der navigationsgestützte schrittweise mediale Bandrelease

Soft tissue management in knees with varus deformity

Computer-assisted sequential medial ligament release

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Zusammenfassung

Hintergrund

Die Varusgonarthrose mit Kontrakturen der Bänder und der dorsalen Kapsel erfordert ein sequenzielles Weichteilmanagement, um eine ausgeglichene Bandspannung in Flexion und Extension zu erreichen. Mit Einführung der Navigation in die Knieendoprothetik wird die Beinachse erstmals intraoperativ messbar.

Methode

10 Kniegelenke von Körperspendern wurden standardisiert navigationsgestützt (Ci®-Navigationssystem, DePuy® I-Orthopaedics®, München) operiert und die Veränderungen der Gesamtbeinachse und die Gap-Weite im Verlauf eines standardisierten medialen sequentiellen Bandreleases mit dem Navigationssystem dokumentiert.

Ergebnisse

Jeder Releaseschritt führte zu einer statistisch signifikanten Veränderung der Beinachse und der Gap-Weite (p<0,001). Der größte Effekt wurde in Extension für den sog. kapsulären 6-cm-Release und den Release des medialen Kollateralbandes in 90° Flexion gesehen.

Schlussfolgerung

Die Navigation ermöglicht in der Knieendoprothetik die Visualisierung und Quantifizierung der einzelnen Releaseschritte und bietet eine wertvolle Hilfestellung.

Abstract

Background

Knees with severe varus deformities and contractures of the medial and lateral collateral ligaments and the posterior capsule require special soft tissue management to gain a stable knee over the full range of movement. The introduction of navigation systems into knee surgery has now made precise measurement of the leg axis and gap size possible.

Methods

Ten knee joints received a computer-assisted total knee replacement (Ci® navigation system DePuy® I-Orthopaedics®, Munich). The change of the leg axis and the size of the mediolateral gaps were measured and documented when performing a standardized medial ligament release sequence.

Results

We found a significant effect after each release step regarding the change of the leg axis as well as the gap width (p<0.001). The highest effect was seen for the 6-cm capsule release in extension and the release of the medial collateral ligament in 90° flexion.

Conclusion

Implementation of computer-assisted navigation facilitates visualization and quantification of the effect of the sequential medial soft tissue release in total knee arthroplasty.

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Authors and Affiliations

  1. Orthopädische Klinik, Universität Regensburg,

    C. Lüring, L. Perlick, H. Bäthis & J. Grifka

  2. Unfallchirurgische Abteilung, Medizinische Hochschule, Hannover

    T. Hüfner & C. Krettek

  3. Orthopädische Klinik, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Regensburg

    C. Lüring

Authors
  1. C. Lüring
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  2. T. Hüfner
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  3. L. Perlick
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  4. H. Bäthis
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  5. C. Krettek
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  6. J. Grifka
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Correspondence to C. Lüring.

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Lüring, C., Hüfner, T., Perlick, L. et al. Weichteilmanagement bei der Varusgonarthrose. Orthopäde 34, 1118–1124 (2005). https://doi.org/10.1007/s00132-005-0851-4

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