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Die modifizierte Lemaire-Technik: Indikation, Eingriff und klinische Ergebnisse

Modified Lemaire Procedure: Indication, procedure, and clinical results

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An Erratum to this article was published on 18 January 2019

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Zusammenfassung

Hintergrund

Der pivotierende Unfallmechanismus bei einer Ruptur des vorderen Kreuzbands (VKB) ist der Grund für begleitende Läsionen anterolateraler Strukturen. Da dieser anterolaterale Komplex die tibiale Innenrotation stabilisiert, wird dessen Läsion für die persistierenden Pivot-Shift-Phänomene trotz technischen Verbesserungen der VKB-Rekonstruktion verantwortlich gemacht. Aus diesem Grund beschäftigen sich Kniechirurgen erneut mit der anterolateralen Stabilisierung als Ergänzung zur VKB-Rekonstruktion.

Studien

Biomechanische sowie klinische Studien zeigten bisher vielversprechende Ergebnisse. Die modifizierte, laterale, extraartikuläre Stabilisierung nach Lemaire als nichtanatomische Rekonstruktion des anterolateralen Ligaments (ALL) brilliert durch eine geringe Morbidität, da eine zusätzliche Sehnenentnahme entfällt. Neben dem möglichen Nutzen bestehen mehrere Risiken und Nachteile. So ist eine vollständige Kontrolle des Pivot-Shift-Phänomens in knapp 8 % der Fälle nicht möglich und bei zu straffer Transplantatspannung kann eine Druckerhöhung im lateralen Kniekompartiment resultieren. Insgesamt wird dieses Thema in der Literatur kontrovers diskutiert. Dieser Artikel schafft einen Überblick und stellt die modifizierte Technik von Lemaire vor.

Abstract

Background

The mechanisms of anterior cruciate ligament (ACR) rupture may include a pivoting mechanism, which is responsible for concomitant lesions of the anterolateral structures. This anterolateral complex is the main stabilizer of tibial internal rotation and therefore accountable for a persisting pivot shift despite technical improvement of ACR reconstruction. For this reason, knee surgeons’ interest in addressing anterolateral stabilization in addition to ACR reconstruction has been renewed.

Studies

Biomechanical and clinical studies have shown promising results so far. The modified, lateral, extra-articular stabilization according to Lemaire as a non-anatomical reconstruction of the anterolateral ligament (ALL) shines with a low morbidity, since no additional tendon harvesting is needed. Besides the potential benefits there are several risks and disadvantages. For example, complete control of the pivot-shift phenomenon is not possible in nearly 8% of cases. In addition, too tight tensioning of the ALL may result in an increase of pressure in the lateral knee compartment. Overall, ALL reconstruction is a hot topic and is heavily discussed in literature. This article provides an overview and brings the modified technique of Lemaire into focus.

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Change history

  • 18 January 2019

    <Emphasis Type="Bold">Erratum zu:</Emphasis>

    <Emphasis Type="Bold">Der Orthopäde 2018</Emphasis>

    <ExternalRef><RefSource>https://doi.org/10.1007/s00132-018-03663-9</RefSource><RefTarget Address="10.1007/s00132-018-03663-9" TargetType="DOI"/></ExternalRef>

    Sehr geehrte Leser,

    sehr geehrte Leserin,

    bei der Online-First-Version des Beitrags „Die modifizierte Lemaire-Technik: Indikation, Eingriff und klinische Ergebnisse“ wurden leider nicht alle beteiligten Autoren namentlich genannt. Bitte beachten Sie die …

Abbreviations

ALL:

Anterolaterales Ligament

IKDC:

International Knee Documentation Commitee

LCL :

Laterales Kollateralband

SD :

Standardabweichung

VKB :

Vorderes Kreuzband

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Authors and Affiliations

  1. Orthopädie und Traumatologie, Bürgerspital Solothurn, 4500, Solothurn, Schweiz

    Andreas Flury, Julian Hasler, Michael Finsterwald, Roland Stefan Camenzind, Näder Helmy & Alexander Antoniadis

  2. Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    Florian Balthasar Imhoff

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Correspondence to Andreas Flury.

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Interessenkonflikt

A. Flury, J. Hasler, F.B. Imhoff, M. Finsterwald, R.S. Camenzin, H. Näder und A. Antoniadis geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor. Das schriftliche Einverständnis von Patienten für das anonymisierte Weiterverwenden und Veröffentlichen von klinischen Daten und Fotografien wurde eingeholt.

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Flury, A., Hasler, J., Imhoff, F.B. et al. Die modifizierte Lemaire-Technik: Indikation, Eingriff und klinische Ergebnisse. Orthopäde 48, 248–256 (2019). https://doi.org/10.1007/s00132-018-03663-9

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