Skip to main content
SpringerLink
Log in

Isolierte und kombinierte Kniebandverletzungen

Anatomie, Biomechanik, Diagnostik, Indikationsstellung, operative Therapie

Treatment of isolated and multiple ligament injuries of the knee

Anatomy, biomechanics, diagnosis, indications for repair, surgery

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die komplexe Knieinstabilität zeichnet sich durch gleichzeitige Verletzung des vorderen (VKB) oder hinteren Kreuzbandes (HKB) sowie in vielen Fällen mindestens einer weiteren wesentlichen Bandstruktur aus. Verletzungen des medialen Kollateralbandes sowie des HKB haben eine hohe Heilungspotenz und können oft konservativ behandelt werden. Indikationen zur operativen Versorgung sind die Instabilität der Meniskusaufhängung, eingeschlagene Bandfasern im Gelenk mit Blockierungen, Knieluxationen mit schwerer Knieinstabilität und dislozierte knöcherne Bandausrisse. Bei Verletzung des lateralen Seitenbandapparates kommt es aufgrund der Bandretraktion nicht zu einer suffizienten Spontanheilung. Daher ist bei relevanter lateraler Knieinstabilität die Indikation zur operativen Bandrekonstruktion in den ersten 2 Wochen nach dem Trauma großzügig zu stellen. Die Indikation zur notfallmäßigen Kniearthroskopie bei isolierten VKB- oder HKB-Rupturen dagegen sollte streng gestellt werden. Bei einer Kniegelenkluxation dürfen die Begleitverletzungen des Gefäß-Nerven-Bündels nicht übersehen werden.

Abstract

Complex knee ligament injuries are characterized by simultaneous rupture of the anterior cruciate ligament (ACL) and/or the posterior cruciate ligament (PCL) and at least one collateral ligament. Isolated injury to the medial collateral ligament (MCL) and PCL have a high healing capacity and can be treated conservatively in many cases. Ruptures of the MCL can also be treated conservatively in complex injuries if the cruciate ligaments are reconstructed. Ruptures of the lateral structures usually need surgical reconstruction. Indications for acute surgical repair include meniscus dislocation, entrapment of collateral ligament portions in the joint, knee dislocation with severe knee instability, and displaced bony avulsions. The anatomy of the knee ligaments must be carefully respected in surgical reconstruction. Acute repair of collateral ligament injuries is possible only in the first 2 weeks after trauma. Acute arthroscopy is indicated only in combination with reconstructive surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. Anderson DR, Weiss JA, Takai S et al (1992) Healing of the medial collateral ligament following a triad injury: a biomechanical and histological study of the knee in rabbits. J Orthop Res 10:485–495

    Article  PubMed  CAS  Google Scholar 

  2. AWMF (2008) Leitlinien für Diagnostik und Therapie – Unfallchirurgie. AWMF, Düsseldorf, AWMF online: http://leitlinien.net/

  3. Baker CL Jr, Norwood LA, Hughston JC (1983) Acute posterolateral rotatory instability of the knee. J Bone Joint Surg Am 65(5):614–618

    PubMed  Google Scholar 

  4. 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 

  5. Chen FS, Rokito AS, Pitman MI (2000) Acute posterolateral rotatory instability of the knee. J Am Acad Orthop Surg 8(2):97–110

    PubMed  CAS  Google Scholar 

  6. Fanelli GC, Orcutt DR, Edson CJ (2005) The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 21:471–486

    PubMed  Google Scholar 

  7. Freeman RT, Duri ZA, Dowd GS (2002) Combined chronic posterior cruciate and posterolateral corner reconstruction of he posterolateral corner. Knee 9(4):309–312

    Article  PubMed  CAS  Google Scholar 

  8. Galla M, Uffmann J, Lobenhoffer P (2004) Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique. Arch Orthop Trauma Surg 124:281–284

    Article  PubMed  Google Scholar 

  9. Hamner DL, Brown CH Jr, Steiner ME et al (1999) Hamstring tendon grafts for reconstruction of he anterior cruciate ligament: biomechanical evaluation of he use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557

    PubMed  CAS  Google Scholar 

  10. Harner CD, Vogrin TM, Hoher J et al (2000) Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28(1):32–39

    PubMed  CAS  Google Scholar 

  11. Herbort M, Weimann A, Zantop T et al (2006) Initial fixation strengt of new hybrid technique for femoral ACL graft fixation: the bone wedge technique. Arch Orthop Trauma Surg 127(9):769–775

    Article  PubMed  Google Scholar 

  12. Hiemstra LA, Heard SM, Sasyniuk TM et al (2009) Knee immobilization for pain control after a hamstring tendon anterior cruciate ligament reconstruction: a randomized clinical trial. Am J Sports Med 37(1):56–64

    Article  PubMed  Google Scholar 

  13. Hinterwimmer S, Krammer M, Krötz M et al (2004) Cartilage atrophy in the knees of patients after seven weeks of partial load bearing. Arthritis Rheum 50(8):2516–2520

    Article  PubMed  CAS  Google Scholar 

  14. Ishibashi Y, Rudy TW, Livesay GA et al (1997) The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy 13:177–182

    PubMed  CAS  Google Scholar 

  15. Jansson KA, Harilainen A, Sandelin J et al (1999) Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 7(5):290–295

    Article  PubMed  CAS  Google Scholar 

  16. Kannus P (1989) Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med 17(1):83–88

    Article  PubMed  CAS  Google Scholar 

  17. Krukhaug Y, Molster A, Rodt A, Strand T (1998) Lateral ligament injuries of he knee. Knee Surg Sports Traumatol Arthrosc 6:21–25

    Article  PubMed  CAS  Google Scholar 

  18. Lobenhoffer P (1999) Kniebandverletzungen. Teil I: Anatomie, Biomechanik, Diagnostik, Indikationsstellung. Chirurg 70:219–230

    Article  PubMed  CAS  Google Scholar 

  19. Lobenhoffer P (1999) Kniebandverletzungen. Teil II: Operative Therapie bei vorderer und hinterer Knieinstabilität. Chirurg 70:326–338

    Article  PubMed  CAS  Google Scholar 

  20. Lobenhoffer P, Gerich T, Hernandez R (1996) Die Therapie von Streckdefiziten durch arthroskopische Arthrolyse und dorsaler Kapsulotomie. Unfallchirurg 99:487–491

    PubMed  CAS  Google Scholar 

  21. Lobenhoffer P, Tausendfreund J, Zeichen J, Bosch U (1999) Operative Therapie der Arthrofibrose. Arthroscopy 12:252–259

    Article  Google Scholar 

  22. Lobenhoffer P, Agneskirchner JD, Galla M (2006) Knienahe Umstellungsosteotomie: Indikation, Planung, Operationstechnik mit Plattenfixateuren. Thieme, Stuttgart

  23. Mayr HO, Weig TG, Plitz W (2004) Arthrofibrosis following ACL reconstruction-reasons and outcome. Arch Orthop Trauma Surg 124:518–522

    Article  PubMed  Google Scholar 

  24. Müller W (1982) Das Knie – Form, Funktion und ligamentäre Wiederherstellungschirurgie. Springer, Heidelberg

  25. Müller B, Rupp S, Kohn D, Seil R (2000) Entnahmestellenproblematik nach vorderer Kreuzbandplastik mit dem mittleren Drittel der Patellarsehne. Unfallchirurg 103:662–667

    Article  PubMed  Google Scholar 

  26. Noyes FR, Barber-Westin SD (1996) Treatment of complex injuries involving the posterior cruciate and posterolateral ligaments of the knee. Am J Knee Surg 9(4):200–214

    PubMed  CAS  Google Scholar 

  27. Noyes FR, Grood ES, Torzilli PA (1989) Current concepts review. The definitions of terms for motion and position of he knee and injuries of he ligaments. J Bone Joint Surg Am 71(3):465–472

    PubMed  CAS  Google Scholar 

  28. Ruße K, Schulz MS, Strobel MJ (2006) Epidemiologie der hinteren Kreuzbandverletzung. Arthroscopy 19:215–220

    Article  Google Scholar 

  29. Scheffler SU, Sudkamp NP, Gockenjan A et al (2002) Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques: the impact of fixation level and fixation method under cyclic loading. Arthroscopy 18:304–315

    Article  PubMed  Google Scholar 

  30. Shelbourne KD, Wilckens JH, Mollabashy, De Carlo M (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction. Am J Sports Med 19:332–336

    Article  PubMed  CAS  Google Scholar 

  31. Stannard JP, Brown SL, Farris RC et al (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33(6):881–888

    Article  PubMed  Google Scholar 

  32. Strobel MJ (2007) Rekonstruktion des vorderen Kreuzbandes mit der Einbündeltechnik. Arthroscopy 20:121–131

    Article  Google Scholar 

  33. Strobel MJ, Castillo RJ, Weiler A (2001) Reflex extension loss after anterior cruciate ligament reconstruction due to femoral „high noon“ graft placement. Arthroscopy 17:408–411

    Article  PubMed  CAS  Google Scholar 

  34. Tsuda E, Fukuda Y, Loh JC et al (2002) The effect of soft-tissue graft fixation in anterior cruciate ligament reconstruction on graft-tunnel motion under anterior tibial loading. Arthroscopy 18:960–967

    PubMed  Google Scholar 

  35. Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability of he knee. Clin Sports Med 13(3):615–627

    PubMed  CAS  Google Scholar 

  36. Woo SL, Vogrin TM, Abramowitch SD (2000) Healing and repair of ligament injuries in the knee. J Am Acad Orthop Surg 8:364–372

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Henriettenstiftung Hannover, Marienstraße 72–90, 30171, Hannover, Deutschland

    O. Yastrebov & P. Lobenhoffer

Authors
  1. O. Yastrebov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Lobenhoffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Yastrebov.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yastrebov, O., Lobenhoffer, P. Isolierte und kombinierte Kniebandverletzungen . Orthopäde 38, 563–580 (2009). https://doi.org/10.1007/s00132-009-1421-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-009-1421-y

Schlüsselwörter

Keywords

Search

Navigation