Die vordere Kreuzbandplastik - Transplantatwahl und Verankerungstechniken

 

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Zusammenfassung

Mit dem Einzug der Arthroskopie wurde eine neue Epoche der Kreuzbandchirurgie eingeleitet. Das Ziel einer Kreuzbandplastik sollte darin bestehen, ein Transplantat und eine Verankerung zu finden, welche hinsichtlich der biomechanischen Eigenschaften dem eines intakten Kreuzbandes nahe kommen. Zur Kreuzbandplastik benötigt man neben einem Transplantat eine suffiziente femorale als auch tibiale, möglichst ossäre Verankerung. Hinsichtlich der Transplantatwahl gilt heute die Verwendung autologer Materialien (Patellarsehnendrittel, Semitendinosus/Grazilissehne, Quadrizepssehne) als Methode der Wahl, in Ausnahmefällen wird auf allogene Materialien zurückgegriffen. Transplantat als auch Verankerung müssen möglichst einer frühfunktionellen Rehabilitation widerstehen. Ergebnisse aus der Grundlagen- und klinischen Forschung haben dazu beigetragen, die verschiedenen Fixationstechniken hinsichtlich ihres Einsatzes zu validieren. Biomechanische und klinische Aspekte von Kreuzbandtransplantaten sowie Verankerungstechniken werden im folgenden Artikel diskutiert.

Abstract

With the introduction of arthroscopy most of the surgeon have changed their technique in ACL-reconstruction from open to arthroscopically performed techniques. Several new techniques have been developed in the past, including new fixation devices and different grafts. The cruciate ligament reconstruction comprises a composition of both, the graft and the fixation to the bone. Well accepted autografts are the patellar midthird, the semitendinosus/gracilis or the quadriceps tendon. In special cases allografts are alternatives. The fixation can cause failure due to overstrain or creep during the postoperative period of healing. Considering their biomechanical properties, cruciate ligament reconstruction should aim for a graft behavior comparable with the native cruciate ligament. Results gained from basic science and clinical studies are reviewed in the following article.

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Roland Becker

Orthopädische Universitätsklinik

„Otto von Guericke” Universität Magdeburg

Leipziger Straße 44

39120 Magdeburg

Phone: 03 91/6 71 40 26

Fax: 03 91/6 71 40 06

Email: roland.becker@medizin.uni-magdeburg.de