Operative Orthopadie und Traumatologie · 2010
[Arthroscopic reconstruction of the anterolateral bundle of the posterior cruciate ligament in single-bundle technique with autologous hamstring grafts].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Petersen Wolf, Zantop Thore
Аннотация
OBJECTIVE: Restoration of the function of the posterior cruciate ligament (PCL).
INDICATIONS: Chronic posterior instability with posterior tibial translation of >10 mm.
CONTRAINDICATIONS: Fixed posterior drawer, local infections at the knee joint, local soft-tissue damage, poor compliance of the patient.
SURGICAL TECHNIQUE: Surgery starts with arthroscopic examination of the knee joint and therapy of associated injuries (meniscus and cartilage injuries). Harvesting of the semitendinosus and gracilis tendons is performed via a 3 cm long skin incision 1 cm distally and medially of the tibial tuberosity. The tendons are folded to a four- or five-stranded graft with a minimum length of 10 cm. The femoral tunnel for the graft is drilled via a deep anterolateral portal under arthroscopic control. For drilling of the tibial tunnel, a posteromedial portal is needed. The tibial insertion of the PCL is debrided with a shaver and a specific raspatory. For tibial tunnel placement, a specific closed aimer is used and a Kirschner wire is placed in the center of the tibial insertion. This Kirschner wire is overdrilled using a cannulated drill with a diameter according to the graft size. After femoral fixation, the graft is tensioned in 90° flexion with 80 N. At the femoral and tibial side, a hybrid fixation is performed with a button (flipp tack) and a resorbable interference screw. If there are any signs of posterolateral instability, a posterolateral corner reconstruction is performed before tensioning and fixation of the PCL graft.
POSTOPERATIVE MANAGEMENT: For 6 weeks, the knee is immobilized in extension with a posterior tibial support (PTS) brace (Medi, Bayreuth, Germany). Passive range of motion exercises should be performed in prone position (first 2 weeks 0-0-30°, 3rd to 4th week 0-0-60°, 5th to 6th week 0-0-90°). After the first 6 weeks, a movable brace is needed at daytime. At nighttime, the patient has to wear the PTS brace.
RESULTS: Between 2003 and 2006, a PCL reconstruction in singlebundle technique was performed in 58 patients. In 42 cases, a simultaneous reconstruction of the posterolateral corner was done. The Lysholm Score improved from 62.2 to 88.4 points, the Tegner Activity Score from 3.3 to 5.4 points.
INDICATIONS: Chronic posterior instability with posterior tibial translation of >10 mm.
CONTRAINDICATIONS: Fixed posterior drawer, local infections at the knee joint, local soft-tissue damage, poor compliance of the patient.
SURGICAL TECHNIQUE: Surgery starts with arthroscopic examination of the knee joint and therapy of associated injuries (meniscus and cartilage injuries). Harvesting of the semitendinosus and gracilis tendons is performed via a 3 cm long skin incision 1 cm distally and medially of the tibial tuberosity. The tendons are folded to a four- or five-stranded graft with a minimum length of 10 cm. The femoral tunnel for the graft is drilled via a deep anterolateral portal under arthroscopic control. For drilling of the tibial tunnel, a posteromedial portal is needed. The tibial insertion of the PCL is debrided with a shaver and a specific raspatory. For tibial tunnel placement, a specific closed aimer is used and a Kirschner wire is placed in the center of the tibial insertion. This Kirschner wire is overdrilled using a cannulated drill with a diameter according to the graft size. After femoral fixation, the graft is tensioned in 90° flexion with 80 N. At the femoral and tibial side, a hybrid fixation is performed with a button (flipp tack) and a resorbable interference screw. If there are any signs of posterolateral instability, a posterolateral corner reconstruction is performed before tensioning and fixation of the PCL graft.
POSTOPERATIVE MANAGEMENT: For 6 weeks, the knee is immobilized in extension with a posterior tibial support (PTS) brace (Medi, Bayreuth, Germany). Passive range of motion exercises should be performed in prone position (first 2 weeks 0-0-30°, 3rd to 4th week 0-0-60°, 5th to 6th week 0-0-90°). After the first 6 weeks, a movable brace is needed at daytime. At nighttime, the patient has to wear the PTS brace.
RESULTS: Between 2003 and 2006, a PCL reconstruction in singlebundle technique was performed in 58 patients. In 42 cases, a simultaneous reconstruction of the posterolateral corner was done. The Lysholm Score improved from 62.2 to 88.4 points, the Tegner Activity Score from 3.3 to 5.4 points.