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Kapselduplikatur nach Hughston

Capsule duplicature using the Hughston procedure

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Das hintere Schrägband („posterior oblique ligament“, POL) als Hauptstruktur der posteromedialen Gelenkecke des Kniegelenks spielt eine wichtige Rolle bei der anteromedialen Rotationsinstabilität. Diese tritt oft in Verbindung mit akuten und chronischen Verletzungen des vorderen Kreuzbands (VKB) auf. Von Hughston wurde 1973 eine Operationstechnik für die Versorgung akuter und chronischer Verletzungen der posteromedialen Strukturen etabliert. Die Kapselduplikatur nach Hughston beinhaltet die Wiederherstellung der Funktion des POL mittels Durchflechtung mit Fadenmaterial, ggf. unter Verwendung von Fadenankern im Knochen. Zusätzlich wird, falls erforderlich, die Semimembranosussehne am proximalen Tibiaplateau nach ventral transponiert und schließlich die ausgelockerte dorsomediale Kapsel unter das oberflächliche Innenband im Sinne einer Kapseldoppelung gesteppt. Die Kapselduplikatur erscheint als eine nützliche Alternative bei mäßiggradigen posteromedialen Instabilitäten mit dem Vorteil, dass keine Sehnenentnahme im Bereich der medial stabilisierenden Hamstringsehnen oder der gesunden Gegenseite notwendig ist.

Abstract

The posterior oblique ligament (POL) as the main component of the posteromedial structures of the knee plays an important role in anteromedial rotatory instability. This often occurs in association with acute and chronic injuries of the anterior cruciate ligament (ACL). A surgical technique for treatment of acute and chronic injuries of the posteromedial structures was first established by Hughston in 1973. The capsule duplicature using the Hughston procedure involves reconstruction of the function of the POL by reefing with suture material, potentially using suture anchors if the tissue is detached from the bone. Additionally, the semimembranous tendon may be advanced anteriorly to improve dynamic stabilization. Finally, the loosened posteromedial capsule is advanced anteriorly and sutured under the superficial medial cruciate ligament in the form of a capsule duplicature. This procedure appears to be useful in cases of moderate posteromedial insufficiency with the advantage that retrieval of a tendon graft from the region of the medial stabilizing hamstring or from the healthy contralateral side is not necessary.

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Authors and Affiliations

  1. SPORTSCLINIC COLOGNE, Praxis für Sporttraumatologie und Gelenkchirurgie, Ostmerheimer Str. 200, 51109, Köln, Deutschland

    Jürgen Höher &  Christoph Offerhaus

  2. Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Hamburg, Deutschland

    Ralf Akoto

Authors
  1. Jürgen Höher
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  2. Christoph Offerhaus
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  3. Ralf Akoto
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Correspondence to Jürgen Höher.

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Interessenkonflikt

J. Höher, C. Offerhaus und R. Akoto geben an, dass kein Interessenkonflikt besteht.

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

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Höher, J., Offerhaus, C. & Akoto, R. Kapselduplikatur nach Hughston. Arthroskopie 30, 32–37 (2017). https://doi.org/10.1007/s00142-016-0109-7

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  • DOI: https://doi.org/10.1007/s00142-016-0109-7

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