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Revision nach VKB-Rekonstruktion

Einzeitiges vs. zweizeitiges Vorgehen

Revision after anterior cruciate ligament reconstruction

Single versus staged procedure

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Revisionsoperationen nach Rekonstruktion des vorderen Kreuzbandes (VKB) stellen häufig eine chirurgische Herausforderung dar. Voraussetzungen für die Planung eines Revisionseingriffs sind eine genaue Erhebung der Versagensursache (atraumatische Ursachen, Retrauma), Beurteilung der Primäroperation (Transplantatverankerung, -wahl, Bohrkanalposition) und deren Folgen (Bohrkanalweiterung) sowie die Erfassung von Begleitpathologien (zusätzliche Instabilitäten, degenerative Veränderungen). Die Bildgebung ist dabei entscheidend, wobei v. a. MRT und CT eine wertvolle Hilfestellung geben können.

Die Entscheidung zum ein- oder zweizeitigen Vorgehen wird von der Größe und Lage der ursprünglichen Bohrkanäle bestimmt. Die exakte anatomische Platzierung des tibialen und femoralen Bohrkanals stellt die wichtigste Vorgabe dar und darf nicht kompromittiert werden. Die Vorteile des zweizeitigen Vorgehens liegen in der Tatsache, dass die Revisionsoperation dann sehr ähnlich einem Primäreingriff durchgeführt werden kann. Die Nachteile liegen v. a. im zeitlichen Aspekt (3–6 Monate zwischen Knochenauffüllung und Revisionsrekonstruktion), im Risiko und der Morbidität eines zusätzlichen Eingriffs. Daher sollte im Sinne des Patienten primär überlegt werden, ob eine Situation einzeitig gelöst werden kann. Dies setzt aber eine Vertrautheit des Operateurs mit unterschiedlichen Operationstechniken und Transplantaten voraus.

Abstract

Revision surgery following failed anterior cruciate ligament (ACL) reconstruction represents a challenging task to the surgeon. The key to success in revision surgery is proper planning of the procedure. This consists of analyzing the cause of failure (atraumatic versus traumatic reasons), evaluating the index procedure (implant fixation, graft choice, tunnel placement) and the consequences of this procedure (tunnel enlargement), as well as detecting additional pathologies (other components of laxity or degenerative changes). Therefore, imaging is extremely important and MRI (for additional pathology) and CT (for tunnel morphology) provide valuable support.

The decision for a single or staged procedure is mainly determined by the size and location of the primary bone tunnels. Anatomic placement of the new tunnels is the main goal and must not be compromised. The advantage of a staged procedure is that revision ACL reconstruction may be performed similarly to a primary procedure. However, the major disadvantage is the time delay of 3–6 months resulting in a prolonged instability period for the joint and prolonged return to work or sports activity for the patient. For the benefit of the patient it should be evaluated if a revision situation can be sufficiently solved in a single stage procedure. In revision situations the surgeon has to be flexible and familiar with all available graft choices and multiple fixation techniques.

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Literatur

  1. Allen CR, Giffin JR, Harner CD (2003) Revision anterior cruciate ligament reconstruction. Orthop Clin North Am 34:79–98

    Article  PubMed  Google Scholar 

  2. Ahn JH, Lee YS, Ha CH (2008) Comparison of revision surgery with primary anterior cruciate ligament reconstruction and outcome of revision surgery between different graft materials. Am J Sports Med 36(10):1889–1895

    Article  PubMed  Google Scholar 

  3. Bach BR Jr (2000) Revision anterior cruciate ligament surgery. Arthroscopy 19 [suppl 1]:14–29

  4. Battaglia MJ, Cordasco FA, Hannafin JA et al (2007) Results of revision anterior cruciate ligament surgery. Am J Sports Med 35:2057–2066

    Article  PubMed  Google Scholar 

  5. Bernhard R, Bach J (2003) Revision anterior cruciate ligament surgery. Arthroscopy 19(10):14–29

    Google Scholar 

  6. Brown CH, Carson EW (1999) Revision anterior cruciate ligament surgery. Clin Sports Med 18(1):109–117

    Article  PubMed  Google Scholar 

  7. Denti M, Vetere DL, Corrado B et al (2008) Revision anterior cruciate ligament reconstruction. Causes of failure, surgical technique and clinical results. Am J Sports Med 36(10):1896–1902

    Article  PubMed  Google Scholar 

  8. Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction. Am J Sports Med 36:851–860

    Article  PubMed  Google Scholar 

  9. Fanelli GC, Edson CJ, Maish DR (2001) Revision anterior cruciate ligament reconstruction: associated patholaxity, tibiofemoral malalignment, rehabilitation, and results. Am J Knee Surg 14:201–204

    CAS  PubMed  Google Scholar 

  10. Garofalo R, Djahangiri A, Siegrist O (2006) Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy 22(2):205–214

    PubMed  Google Scholar 

  11. George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037

    Article  PubMed  Google Scholar 

  12. Grossman MG, El Attrache NS, Shields CL, Glousman RE (2005) Revision anterior cruciate ligament reconstruction: 3- to 9 year follow up. Arthroscopy 21(4):418–423

    PubMed  Google Scholar 

  13. Harner CD, Giffin JR, Dunteman RC et al (2001) Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect 50:463–474

    CAS  PubMed  Google Scholar 

  14. Jaurequito JW, Paulos LE (1996) Why grafts fail. Clin Orthop Relat Res 325:25–41

    Article  Google Scholar 

  15. Johnson D, Harner CD, Maday MG (1994) Revision anterior cruciate ligament surgery. In: Fu F, Harner CD, Vince KG (eds) Knee surgery. Williams & Wilkins, Baltimore, pp 877–895

  16. Kartus J, Stener S, Lindahl S et al (1998) Ipsi- or contralateral patellar tendon graft in anterior cruciate ligament revision surgery. A comparison of two methods. Am J Sports Med 26:499–504

    CAS  PubMed  Google Scholar 

  17. Kaz R, Starman JS, Fu F (2007) Anatomic double-bundle anterior cruciate ligament reconstruction revision surgery. Arthroscopy 23:1250–1253

    Article  PubMed  Google Scholar 

  18. Kohn D, Rupp S (2000) Strategien zu Revisionseingriffen bei fehlgeschlagener vorderer Kreuzbandrekonstruktion. Chirurg 71:1055–1065

    Article  CAS  PubMed  Google Scholar 

  19. Marquass B, Engel T, Hepp P et al (2007) Ein- und zweizeitiges Vorgehen bei Revisionschirurgie des vorderen Kreuzbandes. Z Orthop Unfall 145:712–718

    Article  CAS  PubMed  Google Scholar 

  20. Martinek V, Imhoff AB (2002) Revision of failed anterior cruciate ligament reconstruction. Orthopäde 31(8):778–784

    Article  CAS  PubMed  Google Scholar 

  21. Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts. J Bone Joint Surg [Am] 83(3):1131–1143

    Google Scholar 

  22. Noyes FR, Barber-Westin SD (2006) Anterior cruciate ligament revision reconstruction. Am J Sports Med 34:553–564

    Article  PubMed  Google Scholar 

  23. Pässler HH, Mastrokalos DS, Motsis EK, Liakuo Y (2001) New techniques for anterior cruciate ligament revision surgery. Osteosynth Internat 9:21–30

    Article  Google Scholar 

  24. Proctor CS, Jackson DW, Simon TM (1997) Characterization of the repair tissue after removal of the central one-third of the patellar ligament. An experimental study in a goat model. J Bone Joint Surg [Am] 79:997

    Google Scholar 

  25. Said HG, Baloch K, Green M (2006) A new technique for femoral and tibial tunnel bone grafting using the OATS harvesters in revision anterior cruciate ligament reconstruction. Arthroscopy 22(7):796

    Article  PubMed  Google Scholar 

  26. Samuelsson K, Andersson D, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy 25(10):1139–1174

    Article  PubMed  Google Scholar 

  27. Shen W, Forsythe B, McNeill Ingham S et al (2008) Application of the anatomic double-bundle reconstruction concept to revision and augmentation anterior cruciate ligament surgeries. J Bone Joint Surg [Am] 90:20–34

  28. Shetty GM, Wang JH, Chae IJ (2008) A simple and effective technique of femoral tunnel bone grafting in revision anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 128:1269–1271

    Article  PubMed  Google Scholar 

  29. Spindler KB, Kuhn J, Freedman KB et al (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring. Does it really matter? A systematic review. Am J Sports Med 32:1986–1995

    Article  PubMed  Google Scholar 

  30. Spindler KB, Wuppermann PL (2005) Revision ACL surgery using a two incision technique. Sports Med Arthrosc 13:32–37

    Article  Google Scholar 

  31. Stäubli HU, Schatzmann L, Brunner P et al (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4:100

    Article  PubMed  Google Scholar 

  32. Thomas NP, Kankate R, Wandless F, Pandit H (2005) Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Am J Sports Med 33:1701–1709

    Article  PubMed  Google Scholar 

  33. Weiler A, Schmeling A, Stöhr I et al (2007) Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts. Am J Sports Med 35:1643–1652

    Article  PubMed  Google Scholar 

  34. Wegrzyn J, Chouteau J, Philippot R et al (2009) Repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med 37:776–785

    Article  PubMed  Google Scholar 

  35. Zackary D, Vaughn MD, Schmidt J et al (2009) Biomechanical evaluation of a 1-stage revision anterior cruciate ligament reconstruction technique using a structural bone void filler for femoral fixation. Arthroscopy 25(9):1011–1018

    Google Scholar 

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  1. Sportsclinic Austria GmbH, Stadionstr.1, A-6020, Innsbruck, Österreich

    C. Fink & C. Hoser

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  1. C. Fink
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Correspondence to C. Fink.

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Fink, C., Hoser, C. Revision nach VKB-Rekonstruktion. Arthroskopie 23, 6–13 (2010). https://doi.org/10.1007/s00142-009-0539-6

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  • DOI: https://doi.org/10.1007/s00142-009-0539-6

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