"Ligament bracing"--die augmentierte Kreuzbandnaht: Biomechanische Grundlagen für ein neues Behandlungskonzept

TY - JOUR

T1 - "Ligament bracing"--die augmentierte Kreuzbandnaht: Biomechanische Grundlagen für ein neues Behandlungskonzept

AU - Heitmann, M

AU - Dratzidis, A

AU - Jagodzinski, M

AU - Wohlmuth, P

AU - Hurschler, C

AU - Püschel, K

AU - Giannakos, A

AU - Preiss, A

AU - Frosch, K-H

PY - 2014/7/1

Y1 - 2014/7/1

N2 - BACKGROUND: In the context of acute knee dislocations, suture repair of ruptured cruciate ligaments leads to good clinical results in 80% of cases. Disadvantages are low primary stability and subsequently secondary elongation of the sutured ligaments. In the present study, we compared primary stability of suture repair, reinforced by different suture augments, to cruciate ligament reconstruction.OBJECTIVE: The concept of ligament bracing with transosseous suture repair of the cruciate ligaments and additional suture augmentation is biomechanically superior to cruciate ligament reconstruction.MATERIAL AND METHODS: A total of 42 porcine knee joints divided into seven groups were examined. The stability of four different suture/augmentation combinations were compared to cruciate ligament reconstruction with human hamstring tendons. The investigational setup consisted of testing 1000 cycles with 20 N to 154 N load in a.-p. translation and 60° flexion. Elongation and load to failure were measured.RESULTS: Neither reconstruction (3.13 ± 1.65 mm; 362 ± 51 N) nor augmented suture repair (1.89-2.5 mm; 464-624 N) achieved the primary stability of the intact cruciate ligament (0.63 ± 0.34 mm, 1012 ± 91 N). In comparison to ligament reconstruction, all four augmented suture repairs showed minor elongation in the cyclic test and a higher load to failure. The isolated suture repair showed poor results (6.79 ± 4.86 mm, 177 ± 73 N).CONCLUSION: Augmented suture repair provides significantly higher stability compared with isolated suture repair and reconstruction with hamstring tendons. The concept of ligament bracing could be a promising future treatment option in acute knee dislocations. Clinical results remain to be seen.

AB - BACKGROUND: In the context of acute knee dislocations, suture repair of ruptured cruciate ligaments leads to good clinical results in 80% of cases. Disadvantages are low primary stability and subsequently secondary elongation of the sutured ligaments. In the present study, we compared primary stability of suture repair, reinforced by different suture augments, to cruciate ligament reconstruction.OBJECTIVE: The concept of ligament bracing with transosseous suture repair of the cruciate ligaments and additional suture augmentation is biomechanically superior to cruciate ligament reconstruction.MATERIAL AND METHODS: A total of 42 porcine knee joints divided into seven groups were examined. The stability of four different suture/augmentation combinations were compared to cruciate ligament reconstruction with human hamstring tendons. The investigational setup consisted of testing 1000 cycles with 20 N to 154 N load in a.-p. translation and 60° flexion. Elongation and load to failure were measured.RESULTS: Neither reconstruction (3.13 ± 1.65 mm; 362 ± 51 N) nor augmented suture repair (1.89-2.5 mm; 464-624 N) achieved the primary stability of the intact cruciate ligament (0.63 ± 0.34 mm, 1012 ± 91 N). In comparison to ligament reconstruction, all four augmented suture repairs showed minor elongation in the cyclic test and a higher load to failure. The isolated suture repair showed poor results (6.79 ± 4.86 mm, 177 ± 73 N).CONCLUSION: Augmented suture repair provides significantly higher stability compared with isolated suture repair and reconstruction with hamstring tendons. The concept of ligament bracing could be a promising future treatment option in acute knee dislocations. Clinical results remain to be seen.

KW - Animals

KW - Anterior Cruciate Ligament

KW - Anterior Cruciate Ligament Reconstruction

KW - Equipment Design

KW - Equipment Failure Analysis

KW - Humans

KW - In Vitro Techniques

KW - Stress, Mechanical

KW - Suture Techniques

KW - Sutures

KW - Swine

KW - Tensile Strength

U2 - 10.1007/s00113-014-2563-x

DO - 10.1007/s00113-014-2563-x

M3 - SCORING: Zeitschriftenaufsatz

C2 - 24893725

VL - 117

SP - 650

EP - 657

JO - UNFALLCHIRURGIE

JF - UNFALLCHIRURGIE

SN - 0177-5537

IS - 7

ER -