Zusammenfassung
Operationsziel
Rekonstruktion der medialen Kollateralbandstrukturen zur Stabilisierung des Kniegelenks bei chronischen Instabilitäten.
Indikationen
Chronische Instabilitäten des medialen Kollateralbandes (MCL) isoliert oder kombiniert multiligamentär.
Kontraindikationen
Refixierbare knöcherne Bandausrisse, eingeschränkte Beweglichkeit, Arthrofibrose, ausgeprägte Valgusdeformität, Infektsituationen, kritische Weichteilverhältnisse, mangelnde Patientencompliance, offene Wachstumsfugen.
Operationstechnik
Entnahme der Semitendinosussehne der kontralateralen Seite und Präparation der Sehne. Rückenlagerung mit zu rekonstruierendem Bein im elektrischen Beinhalter. Schräger Hautschnitt auf Höhe des Pes anserinus parallel zu den Sehnen. Distal des tibialen Ansatzes der Hamstringsehnen Setzen eines Bohrlochs in den Ursprung des oberflächlichen MCL-Ansatzes, Einziehen des Sehnentransplantats und Fixation mittels Interferenzschraube. Subfasziale Tunnelung nach proximal, femorale Fixation des Transplantats distal des Ansatzes des medialen patellofemoralen Ligaments (MPFL) in 30° Flexion unter radiologischer Kontrolle. Tibiale Fixation des dorsalen Transplantatanteils ventral des Ansatzes der Semimembranosussehne in Extensionsstellung.
Weiterbehandlung
Teilbelastung von 20 kg für 4–6 Wochen, seitlich stabilisierende Orthesenbehandlung unter Bewegungslimitierung Extension/Flexion 0/0/90°.
Ergebnisse
Insgesamt 9 Patienten im Alter von 18–70 Jahren (Median 39 Jahre) erhielten eine Augmentation des medialen Kollateralbandkomplexes bei chronischer medialer Instabilität des Kniegelenks in der beschriebenen Technik. Die Nachuntersuchung erfolgte nach 11–56 Monaten (Median 16 Monate). Alle Patienten berichteten über ein subjektiv stabiles Kniegelenk. Der mittlere Lysholm-Score lag im Rahmen der Nachuntersuchung bei 90 (72–96) Punkten. Der Tegner-Score betrug vor dem Unfall 4 (2–6) und bei der Nachuntersuchung 3 (2–6) Punkte. Bei der Nachuntersuchung konnte keine zweit- oder drittgradige mediale Instabilität mehr festgestellt werden. Komplikationen traten im Rahmen der vorgestellten Operationstechnik nicht auf.
Abstract
Objective
Medial collateral ligament reconstruction in chronic unstable knees.
Indications
Chronic instability of the medial collateral ligament (MCL) isolated or in combination with multiligament injuries.
Contraindications
Refixable bony avulsions, limited range of motion, arthrofibrosis, severe valgus deformity, infections, critical soft tissue, lack of patient compliance and open growth plates.
Surgical technique
Harvesting of the contralateral semitendinosus tendon and preparation. Supine position with leg in electric leg holder. Oblique skin incision above the pes anserinus parallel to the tendons. Placement of drill hole distal to the tibial insertion of the hamstrings in the footprint of the MCL. Tapering and fixation of the transplant. Subfascial tunneling and femoral fixation of the transplant distally to the medial patellofemoral ligament (MPFL) origin in 30° flexion under fluoroscopic control. Tibial fixation of the dorsal portion of the transplant (POL) ventral to the semimembranosus tendon footprint in full extension.
Postoperative management
Limited weight bearing with 20 kg for 4–6 weeks, stabilizing brace with limited range of motion 0/0/90°.
Results
A total of 9 patients with a median age of 39 (18–70) years received an augmentation of the MCL complex due to a chronic instability using the described technique. Follow-up examination was performed after 16 (11–56) months. All patients reported a stable knee. The median value of the Lysholm score at follow-up was 90 (72–96) points and the Tegner score prior to trauma was 4 (2–6) points and 3 (2–6) points during follow-up. No grade 2 or 3 instability could be observed during follow-up. There were no complications using the above mentioned technique.
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Preiss, A., Giannakos, A. & Frosch, KH. Minimal-invasive Augmentation des medialen Kollateralbandes mit autologen Hamstringsehnen bei chronischen Instabilitäten am Kniegelenk. Oper Orthop Traumatol 24, 335–347 (2012). https://doi.org/10.1007/s00064-012-0164-9
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DOI: https://doi.org/10.1007/s00064-012-0164-9