Versorgung knöcherner hinterer kreuzbandausrisse über einen minimal-invasiven dorsalen zugang

TY - JOUR

T1 - Versorgung knöcherner hinterer kreuzbandausrisse über einen minimal-invasiven dorsalen zugang

AU - Frosch, K -H

AU - Proksch, N

AU - Preiss, A

AU - Giannakos, A

PY - 2012/9

Y1 - 2012/9

N2 - OBJECTIVE: Reduction and fixation of bony avulsions of the posterior cruciate ligament (PCL) through a minimally invasive dorsal approach to restore stability of the knee joint. Prevention of soft tissue damage through a minimally invasive procedure and achieving early functional rehabilitation by stable osteosynthesis.INDICATIONS: Bony tibial avulsions of the PCL and simple posteromedial tibial fractures.CONTRAINDICATIONS: Infections in or around the knee, critical soft tissue conditions and lack of patient compliance. OPERATION TECHNIQUE: Supine position, skin incision mediodorsal over the head of the medial gastrocnemius muscle. After dissection of soft tissue and superficial fascia the medial gasteocnemius muscle is retracted to the lateral side, nerves and vessels of the popliteal fossa are thereby protected. Incision of the posterior capsule from the tibial attachment, exposure of the fracture and the PCL, reduction of the fracture, fixation with two drill wires and definitive fixation with two cannulated screws. In case of multifragment fracture a suture anchor is used for fixation.POSTOPERATIVE MANAGEMENT: Partial weight bearing of 10-20 kg for 4-6 weeks and limitation of knee flexion up to 90° for 4 weeks.RESULTS: Between November 2010 and November 2011 three patients were treated with the new minimally invasive posteromedial approach to fix bony avulsions of the PCL. In two cases an osteosynthesis with two screws was performed and in the other patient a comminuted avulsion fracture was fixed with a suture anchor. In the latter patient the posterolateral corner was additionally augmented according to Larson with an autologous semitendinosus tendon. No intraoperative or postoperative complications could be observed. In all three patients an excellent fracture reduction without steps or gaps could be achieved. In two cases an early functional treatment protocol and in one case (suture anchor fixation plus augmentation of the posterolateral corner) a special postoperative PCL rehabilitation protocol was used. Good clinical results with stable knee joints could be achieved in all cases. The minimally invasive dorsal approach for the treatment of bony avulsions of the PCL was demonstrated to be safe and simple with a low complication rate.

AB - OBJECTIVE: Reduction and fixation of bony avulsions of the posterior cruciate ligament (PCL) through a minimally invasive dorsal approach to restore stability of the knee joint. Prevention of soft tissue damage through a minimally invasive procedure and achieving early functional rehabilitation by stable osteosynthesis.INDICATIONS: Bony tibial avulsions of the PCL and simple posteromedial tibial fractures.CONTRAINDICATIONS: Infections in or around the knee, critical soft tissue conditions and lack of patient compliance. OPERATION TECHNIQUE: Supine position, skin incision mediodorsal over the head of the medial gastrocnemius muscle. After dissection of soft tissue and superficial fascia the medial gasteocnemius muscle is retracted to the lateral side, nerves and vessels of the popliteal fossa are thereby protected. Incision of the posterior capsule from the tibial attachment, exposure of the fracture and the PCL, reduction of the fracture, fixation with two drill wires and definitive fixation with two cannulated screws. In case of multifragment fracture a suture anchor is used for fixation.POSTOPERATIVE MANAGEMENT: Partial weight bearing of 10-20 kg for 4-6 weeks and limitation of knee flexion up to 90° for 4 weeks.RESULTS: Between November 2010 and November 2011 three patients were treated with the new minimally invasive posteromedial approach to fix bony avulsions of the PCL. In two cases an osteosynthesis with two screws was performed and in the other patient a comminuted avulsion fracture was fixed with a suture anchor. In the latter patient the posterolateral corner was additionally augmented according to Larson with an autologous semitendinosus tendon. No intraoperative or postoperative complications could be observed. In all three patients an excellent fracture reduction without steps or gaps could be achieved. In two cases an early functional treatment protocol and in one case (suture anchor fixation plus augmentation of the posterolateral corner) a special postoperative PCL rehabilitation protocol was used. Good clinical results with stable knee joints could be achieved in all cases. The minimally invasive dorsal approach for the treatment of bony avulsions of the PCL was demonstrated to be safe and simple with a low complication rate.

KW - Adult

KW - Bone Screws

KW - Female

KW - Fracture Fixation, Internal

KW - Humans

KW - Intra-Articular Fractures

KW - Joint Instability

KW - Knee Injuries

KW - Male

KW - Minimally Invasive Surgical Procedures

KW - Posterior Cruciate Ligament

KW - Postoperative Care

KW - Postoperative Complications

KW - Radiography

KW - Surgical Instruments

KW - Suture Anchors

KW - Journal Article

U2 - 10.1007/s00064-012-0208-1

DO - 10.1007/s00064-012-0208-1

M3 - SCORING: Zeitschriftenaufsatz

C2 - 23010885

VL - 24

SP - 348

EP - 353

JO - OPER ORTHOP TRAUMATO

JF - OPER ORTHOP TRAUMATO

SN - 0934-6694

IS - 4-5

ER -