Ligament bracing--Augmentierte Primärnaht bei multiligamentären Verletzungen des Kniegelenks

TY - JOUR

T1 - Ligament bracing--Augmentierte Primärnaht bei multiligamentären Verletzungen des Kniegelenks

AU - Heitmann, M

AU - Gerau, M

AU - Hötzel, J

AU - Giannakos, A

AU - Frosch, K-H

AU - Preiss, A

PY - 2014/2

Y1 - 2014/2

N2 - OBJECTIVE: Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation.INDICATIONS: Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury.CONTRAINDICATIONS: Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance.SURGICAL TECHNIQUE: Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization.POSTOPERATIVE MANAGEMENT: Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks.RESULTS: In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.

AB - OBJECTIVE: Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation.INDICATIONS: Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury.CONTRAINDICATIONS: Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance.SURGICAL TECHNIQUE: Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization.POSTOPERATIVE MANAGEMENT: Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks.RESULTS: In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.

KW - Adolescent

KW - Adult

KW - Braces

KW - Equipment Failure Analysis

KW - Female

KW - Humans

KW - Knee Dislocation

KW - Knee Injuries

KW - Ligaments, Articular

KW - Male

KW - Middle Aged

KW - Multiple Trauma

KW - Prosthesis Design

KW - Suture Techniques

KW - Treatment Outcome

KW - Young Adult

KW - Clinical Trial

KW - English Abstract

KW - Journal Article

U2 - 10.1007/s00064-013-0263-2

DO - 10.1007/s00064-013-0263-2

M3 - SCORING: Zeitschriftenaufsatz

C2 - 24553686

VL - 26

SP - 19

EP - 29

JO - OPER ORTHOP TRAUMATO

JF - OPER ORTHOP TRAUMATO

SN - 0934-6694

IS - 1

ER -