Skip to main content
SpringerLink
Log in

Mediale Gonarthrosen mit Kreuzbanddefekt

Kombinierte Versorgung mittels unikondylärer Endoprothese und additivem Kreuzbandersatz

Minimally invasive unicondylar knee arthroplasty with simultaneous ACL reconstruction

Treatment of medial compartment osteoarthritis and cruciate ligament defect

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Geringe postoperative Schmerzen, eine rasche Rehabilitation, kurze stationäre Liegezeiten sowie eine kaum gestörte Achsenkinetik bilden die Vorteile der unikondylären Versorgung von medialen Arthrosen. Notwendige Voraussetzung hierfür sind eine muskuläre und ligamentäre Stabilität. Bei biologisch jungen, aktiven Patienten (<60 Jahre) mit einer isolierten medialen Gonarthrose und zusätzlicher vorderer Kreuzbandinsuffizienz ist der unikondyläre Gelenkersatz kontraindiziert. Um in diesen Fällen die Vorzüge der unikondylären Endoprothese bei lokalisierter Arthrose nutzen zu können, ist die Wiederherstellung der Bandstabilität notwendig.

Material und Methoden

Mit diesem Ziel implantierten wir an ausgewählten Patienten eine unikondyläre Endoprothese und führten zusätzlich eine vordere Kreuzbandplastik durch. Von 2003–2006 operierten wir 32 Fälle mit dieser Kombinationsoperation und untersuchten sie in einem Follow-up von 31 (10–38) Monaten nach.

Ergebnisse

Der Knee-Society-Score (KSS) erhöhte sich signifikant von präoperativ durchschnittlich 83,2 (44–103) auf 167,6 (145–177) nach 31 (10–38) Monaten (Wilcoxon-Test, p<0,05).

Schlussfolgerung

Wenngleich Langzeitergebnisse fehlen und größere Patientenkollektive für fundierte Aussagen unabdingbar sind, ermutigen die erfolgreiche Rehabilitation und die Steigerung im KSS und könnten somit Anlass zur Erweiterung des Indikationsspektrums für den unikondylären Oberflächenersatz geben.

Abstract

Background

Low postoperative pain level, decreased length of hospital stay and accelerated rehabilitation are the major benefits of unicondylar knee arthroplasty. Especially in comparably young, not yet retired and still active patients with an isolated medial gonarthrosis, these prostheses offer many advantages. However, one important requirement to be treated with such implants is a well functioning stability system of the muscles and ligaments. Thus in patients with degenerated or destroyed anterior cruciate ligaments it is contraindicated to use this method. In order to still take advantage of this therapy for treatment of isolated arthrosis, reestablishment of the proprioceptive structures through simultaneous or staged ACL reconstruction is mandatory.

Patients and methods

Pursuing this goal we performed unicondylar knee arthroplasty with simultaneous ACL reconstruction on eligible patients. Between 2003 and 2006 we treated 32 knees with this combined surgery and followed them for a mean of 31 months (range: 10–38).

Results

The mean Knee Society Score significantly improved from 83.2 (44–103) to 167.6 (145–177) at a mean follow-up of 31 months (10–38).

Conclusions

Preliminary results of this short-term follow-up are promising. Especially the predominant number of patients who were able to return to work soon after rehabilitation and the significantly improved score postoperatively reflect the benefits of this prosthesis system in select patients. However, long-term follow-up and larger case numbers are necessary to confirm these encouraging results in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Agneskirchner J, Burkart A, Imhoff A (2002) Achsenfehlstellung, Knorpelschaden und Kreuzbandruptur-Begleiteingriffe bei der VKB Plastik. Unfallchirurg 105: 237–245

    Article  PubMed  CAS  Google Scholar 

  2. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al. (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124: 575–584

    Article  PubMed  CAS  Google Scholar 

  3. Anderson AF, Snyder RB, Federspiel CF, Lipscomb AB (1992) Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med 20: 135–140

    Article  PubMed  CAS  Google Scholar 

  4. Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM (2002) Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am 84: 2235–2239

    PubMed  Google Scholar 

  5. Banks SA, Fregly BJ, Boniforti F et al. (2005) Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc 13: 551–556

    Article  PubMed  Google Scholar 

  6. Callahan CM, Drake BG, Heck DA, Dittus RS (1995) Patient outcomes following unicompartmental or bicompartmental knee arthroplasty. A meta-analysis. J Arthroplasty 10: 141–150

    Article  PubMed  CAS  Google Scholar 

  7. Engh GA, Ammeen D (2004) Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement? Clin Orthop Relat Res 428: 170–173

    Article  PubMed  Google Scholar 

  8. Fuchs S, Frisse D, Tibesku CO et al. (2002) Proprioceptive function, clinical results, and quality of life after unicondylar sledge prostheses. Am J Phys Med Rehabil 81: 478–482

    Article  PubMed  CAS  Google Scholar 

  9. Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ (1988) The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 70: 692–701

    PubMed  CAS  Google Scholar 

  10. Imhoff AB, Linke RD, Agneskirchner J (2004) Corrective osteotomy in primary varus, double varus and triple varus knee instability with cruciate ligament replacement. Orthopade 33: 201–207

    Article  PubMed  CAS  Google Scholar 

  11. Incavo SJ, Mullins ER, Coughlin KM et al. (2004) Tibiofemoral kinematic analysis of kneeling after total knee arthroplasty. J Arthroplasty 19: 906–910

    Article  PubMed  Google Scholar 

  12. Ivarsson I, Gillquist J (1991) Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty. A comparative study. Clin Orthop Relat Res 266: 139–144

    PubMed  Google Scholar 

  13. Jonha NM (1999) Long term osteoarthritic changes in anteror cruciate ligament reconstructed knees. Clin Orthop 358: 188–193

    Google Scholar 

  14. Jung TM, Strobel MJ, Weiler A (2006) Diagnostics and treatment of posterior cruciate ligament injuries. Unfallchirurg 109: 41–60

    Article  PubMed  CAS  Google Scholar 

  15. Kirschner S, Lutzner J, Fickert S, Gunther KP (2006) Revision of unicompartmental knee arthroplasty. Orthopade 35: 184–191

    Article  PubMed  CAS  Google Scholar 

  16. Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 273: 151–156

    PubMed  Google Scholar 

  17. McDaniel W, Dameron T (1983) The untreated anterior cruciate ligament rupture. Clin Orthop 172: 158–163

    PubMed  Google Scholar 

  18. Moller JT, Weeth RE, Keller JO, Nielsen S (1985) Unicompartmental arthroplasty of the knee. Cadaver study of the importance of the anterior cruciate ligament. Acta Orthop Scand 56: 120–123

    Article  PubMed  CAS  Google Scholar 

  19. Newman JH, Ackroyd CE, Shah NA (1998) Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 80: 862–865

    Article  PubMed  CAS  Google Scholar 

  20. O’Connor DP, Laughlin MS, Woods GW (2005) Factors related to additional knee injuries after anterior cruciate ligament injury. Arthroscopy 21: 431–438

    Google Scholar 

  21. Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 85: 1968–1973

    PubMed  Google Scholar 

  22. Pfeil J, Hasch E (2005) Transposition osteotomy on the knee joint. Z Orthop Ihre Grenzgeb 143: 43–64

    Article  Google Scholar 

  23. Price AJ, Webb J, Topf H et al. (2001) Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 16: 970–976

    Article  PubMed  CAS  Google Scholar 

  24. Rajasekhar C, Das S, Smith A (2004) Unicompartmental knee arthroplasty. 2- to 12-year results in a community hospital. J Bone Joint Surg Br 86: 983–985

    Article  PubMed  CAS  Google Scholar 

  25. Saxler G, Temmen D, Bontemps G (2004) Medium-term results of the MC-unicompartmental knee arthroplasty. Knee 11: 349–355

    Article  PubMed  Google Scholar 

  26. Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. Knee 8: 187–194

    Article  PubMed  CAS  Google Scholar 

  27. Tinius M, Klima S, Marquass B et al. (2006) Revision possibilities after failed unicompartmental knee arthroplasty-an analysis of 116 revisions. Z Orthop Ihre Grenzgeb 144: 367–372

    Article  PubMed  CAS  Google Scholar 

  28. Tinius M, Klima S, Tinius W, Josten C (2006) Reconstruction of the ligamentum cruciatum anterius during the performance of unicondylar knee arthroplasty by minimally invasiv surgery: a salvage procedure for monocondylar arthrosis and downfall of the anterior cruciate ligament. Unfallchirurg 109: 1104–1108

    Article  PubMed  CAS  Google Scholar 

  29. Vorlat P, Putzeys G, Cottenie D et al. (2005) The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis. Knee Surg Sports Traumatol Arthrosc 14: 40–45

    Article  PubMed  Google Scholar 

  30. Weale AE, Newman JH (1994) Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12- to 17-year follow-up period. Clin Orthop Relat Res 302: 134–137

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Praxisklinik-Stollberg, Hohensteiner Straße 56, 09366, Stollberg, Deutschland

    M. Tinius & W. Tinius

  2. Department of Orthopedic Surgery, New England Baptist Hospital, Boston, USA

    T.M. Ecker

  3. Klinik und Poliklinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Universität Leipzig AöR, Leipzig, Deutschland

    S. Klima & C. Josten

Authors
  1. M. Tinius
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T.M. Ecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Klima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Tinius
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Josten
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Tinius.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tinius, M., Ecker, T., Klima, S. et al. Mediale Gonarthrosen mit Kreuzbanddefekt. Unfallchirurg 110, 1030–1038 (2007). https://doi.org/10.1007/s00113-007-1356-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-007-1356-x

Schlüsselwörter

Keywords

Search

Navigation