Ersatzplastik des vorderen Kreuzbands in „All-inside“-Technik

Technik, Vor‑, Nachteile und Outcome
  • M. Auerswald
  • D. Rundt
  • S. Breer
  • O. Dannenberg
  • S. Fuchs
  • B. Kienast
Übersichten

Zusammenfassung

Die Ruptur des vorderen Kreuzbands (VKB) hat umfangreiche Konsequenzen für den Betroffenen. Mit der aufgehobenen anterioren Stabilität des Kniegelenks geht häufig ein rapider Gelenkverschleiß einher. Um diesen Pathomechanismus zu durchbrechen, ist die Wiederherstellung der Gelenkstabilität essenziell, was durch die Implantation einer VKB-Ersatzplastik zu bewerkstelligen ist. Seit der ersten beschriebenen operativen Intervention am VKB hat sich die Kreuzbandchirurgie ständig weiterentwickelt. Inzwischen stehen komplett minimalinvasive Verfahren zur Verfügung, die eine frühzeitige Rehabilitation und damit baldige Wiederaufnahme des Leistungsniveaus von vor der Verletzung ermöglichen. Der vorliegende Beitrag stellt Vor- und Nachteile einer Form der All-inside-Technik vor, in der auf die Anlage der klassischen, insbesondere des transtibialen Knochentunnels verzichtet wird. Bei diesem Vorgehen werden minimalinvasiv gebohrte Sacklöcher als Implantatlager verwendet, deren Lage nach arthroskopischem Befund frei wählbar ist und die so einen anatomischen Verlauf der VKB-Plastik ermöglichen.

Schlüsselwörter

Kniegelenk Gelenkinstabilität Arthroskopie Sackloch Minimalinvasiv 

Reconstruction of the anterior cruciate ligament in all-inside technique

Technique, advantages, disadvantages and outcome

Abstract

Rupture of the anterior cruciate ligament (ACL) has extensive consequences for those affected. The lack of stability is often accompanied by rapid abrasion of the joint. In order to counteract this pathomechanism restoration of joint stability is essential, which can be accomplished by implantation of an ACL. Since the first description of an operative intervention on the ACL the surgical technique has continuously developed. Currently, completely minimally invasive procedures are available, which enable early rehabilitation and therefore a quicker return to the performance level prior to injury. This article presents the advantages and disadvantages of a form of the all-inside technique in which the placement of the classical, in particular the transtibial bone tunnel is redundant. With this approach sockets are bored as implant positions by a minimally invasive procedure. The position is freely selectable according to the arthroscopic findings and so enables an anatomical course of the ACL reconstruction.

Keywords

Knee joint Joint instability Arthroscopy Socket Minimally invasive 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Auerswald, D. Rundt, S. Breer, O. Dannenberg, S. Fuchs und B. Kienast geben an, dass kein Interessenkonflikt besteht.

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

The supplement containing this article is not sponsored by industry.

Literatur

  1. 1.
    Aboalata M, Elazab A, Halawa A et al (2017) The crossing internal suture augmentation technique to protect the all-inside anterior cruciate ligament reconstruction graft. Arthrosc Tech 6:e2235–e2240.  https://doi.org/10.1016/j.eats.2017.08.038 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Alentorn-Geli E, Mendiguchía J, Samuelsson K et al (2014) Prevention of anterior cruciate ligament injuries in sports. Part I: systematic review of risk factors in male athletes. Knee Surg Sports Traumatol Arthrosc 22:3–15.  https://doi.org/10.1007/s00167-013-2725-3 CrossRefPubMedGoogle Scholar
  3. 3.
    Benea H, d’Astorg H, Klouche S et al (2014) Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study. Knee 21:102–106.  https://doi.org/10.1016/j.knee.2013.09.006 CrossRefPubMedGoogle Scholar
  4. 4.
    Boden BP, Dean GS, Feagin JA, Garrett WE (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23:573–578PubMedGoogle Scholar
  5. 5.
    Boden BP, Sheehan FT, Torg JS, Hewett TE (2010) Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg 18:520–527CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Burnham JM, Malempati CS, Carpiaux A et al (2017) Anatomic femoral and tibial tunnel placement during anterior cruciate ligament reconstruction: anteromedial portal all-inside and outside-in techniques. Arthrosc Tech 6:e275–e282.  https://doi.org/10.1016/j.eats.2016.09.035 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chambat P, Guier C, Sonnery-Cottet B et al (2013) The evolution of ACL reconstruction over the last fifty years. Int Orthop 37:181–186.  https://doi.org/10.1007/s00264-012-1759-3 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Erickson BJ, Harris JD, Cvetanovich GL et al (2013) Performance and return to sport after anterior cruciate ligament reconstruction in male major league soccer players. Orthop J Sports Med.  https://doi.org/10.1177/2325967113497189 Google Scholar
  9. 9.
    Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225.  https://doi.org/10.1016/j.arthro.2007.09.008 CrossRefPubMedGoogle Scholar
  10. 10.
    Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150CrossRefPubMedGoogle Scholar
  11. 11.
    Gwinn DE, Wilckens JH, McDevitt ER et al (2000) The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med 28:98–102.  https://doi.org/10.1177/03635465000280012901 CrossRefPubMedGoogle Scholar
  12. 12.
    Hootman JM, Dick R, Agel J (2007) Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 31142:311–319Google Scholar
  13. 13.
    Hwang MD, Piefer JW, Lubowitz JH (2012) Anterior cruciate ligament tibial footprint anatomy: systematic review of the 21st century literature. Arthroscopy 28:728–734.  https://doi.org/10.1016/j.arthro.2011.11.025 CrossRefPubMedGoogle Scholar
  14. 14.
    Kim HS, Seon JK, Jo AR (2013) Current trends in anterior cruciate ligament reconstruction. Knee Surg Relat Res 25:165–173.  https://doi.org/10.5792/ksrr.2013.25.4.165 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238.  https://doi.org/10.1007/s001670050056 CrossRefPubMedGoogle Scholar
  16. 16.
    Laible C, Sherman OH (2014) Risk factors and prevention strategies of non-contact anterior cruciate ligament injuries. Bull Hosp Joint Dis 72:70–75Google Scholar
  17. 17.
    Liu SH, al-Shaikh R, Panossian V et al (1996) Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament. J Orthop Res 14:526–533.  https://doi.org/10.1002/jor.1100140405 CrossRefPubMedGoogle Scholar
  18. 18.
    Lubowitz JH, Amhad CH, Anderson K, Anderson K (2011) All-inside anterior cruciate ligament graft-link technique: second-generation, no-incision anterior cruciate ligament reconstruction. Arthroscopy 27:717–727.  https://doi.org/10.1016/j.arthro.2011.02.008 CrossRefPubMedGoogle Scholar
  19. 19.
    Lubowitz JH, Schwartzberg R, Smith P (2013) Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Arthroscopy 29:1195–1200.  https://doi.org/10.1016/j.arthro.2013.04.009 CrossRefPubMedGoogle Scholar
  20. 20.
    Markatos K, Kaseta MK, Lallos SN et al (2013) The anatomy of the ACL and its importance in ACL reconstruction. Eur J Orthop Surg Traumatol 23:747–752.  https://doi.org/10.1007/s00590-012-1079-8 CrossRefPubMedGoogle Scholar
  21. 21.
    Mayo Robson AW (1902) Ruptured crucial ligaments and their repair by operation. Ann Surg 37:716–718Google Scholar
  22. 22.
    Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288CrossRefPubMedGoogle Scholar
  23. 23.
    Piefer JW, Pflugner TR, Hwang MD, Lubowitz JH (2012) Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature. Arthroscopy 28:872–881.  https://doi.org/10.1016/j.arthro.2011.11.026 CrossRefPubMedGoogle Scholar
  24. 24.
    Reda W, Khedr A (2017) Stump incorporation for anterior cruciate ligament reconstruction: a step towards a more anatomical reconstruction. Arthrosc Tech 6:e1303–e1307.  https://doi.org/10.1016/j.eats.2017.05.007 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rupp S, Kohn D (2002) The anterior cruciate ligament as focus of interest. Orthopäde 31:701CrossRefPubMedGoogle Scholar
  26. 26.
    de Sa D, Shanmugaraj A, Weidman M et al (2018) All-inside anterior cruciate ligament reconstruction – a systematic review of techniques, outcomes, and complications. J Knee Surg.  https://doi.org/10.1055/s-0038-1627446 PubMedGoogle Scholar
  27. 27.
    Schiffner E, Latz D, Grassmann JP et al (2018) Anterior cruciate ligament ruptures in German elite soccer players: epidemiology, mechanisms, and return to play. Knee.  https://doi.org/10.1016/j.knee.2018.01.010 PubMedGoogle Scholar
  28. 28.
    Smith PA, Stannard JP, Pfeiffer FM et al (2016) Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large-animal model. Arthroscopy 32:1086–1097.  https://doi.org/10.1016/j.arthro.2015.11.026 CrossRefPubMedGoogle Scholar
  29. 29.
    Stähelin AC, Weiler A (1997) All-inside anterior cruciate ligament reconstruction using semitendinosus tendon and soft threaded biodegradable interference screw fixation. Arthroscopy 13:773–779CrossRefPubMedGoogle Scholar
  30. 30.
    Uhorchak JM, Scoville CR, Williams GN et al (2003) Risk factors associated with Noncontact injury of the anterior cruciate ligament. Am J Sports Med 31:831–842.  https://doi.org/10.1177/03635465030310061801 CrossRefPubMedGoogle Scholar
  31. 31.
    Vaishya R, Agarwal AK, Ingole S, Vijay V (2015) Current trends in anterior cruciate ligament reconstruction: a review. Cureus 7(378):e378.  https://doi.org/10.7759/cureus PubMedPubMedCentralGoogle Scholar
  32. 32.
    Wan C, Hao Z, Li Z, Lin J (2017) Finite element simulations of different hamstring tendon graft lengths and related fixations in anterior cruciate ligament reconstruction. Med Biol Eng Comput 55:2097–2106.  https://doi.org/10.1007/s11517-017-1637-7 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • M. Auerswald
    • 1
  • D. Rundt
    • 1
  • S. Breer
    • 1
  • O. Dannenberg
    • 1
  • S. Fuchs
    • 1
  • B. Kienast
    • 1
  1. 1.Abteilung für Unfallchirurgie, Orthopädie und SporttraumatologieBG-Klinikum HamburgHamburgDeutschland

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