Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery

Georg Mattiassich; Reinhold Ortmaier; Harald Kindermann; Jürgen Barthofer; Imre Vasvary; Stefan Tino Kulnik; Klaus Katzensteiner; Iris Leister

doi:10.1055/a-1281-8627

Sportverletzung · Sportschaden, Inhaltsverzeichnis

Sportverletz Sportschaden 2021; 35(02): 103-114
DOI: 10.1055/a-1281-8627

Originalarbeit

Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery

Klinische und radiologische Ergebnisse nach Naht des vorderen Kreuzbandes mittels Internal-Brace- und All-inside-Kreuzbandersatzplastik nach 12–18 Monaten nach Operation

Georg Mattiassich

¹Trauma Center Graz, Teaching Hospital of the Medical University Graz, Graz, Austria

²Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria

,

Reinhold Ortmaier

³Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Austria

⁴Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Hall in Tirol, Austria

,

Harald Kindermann

⁵Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, Steyr, Austria

,

Jürgen Barthofer

⁶Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria

,

Imre Vasvary

⁷Department of Radiology, Diakonissen Wehrle, Salzburg, Austria

⁸Department of Radiology, Landeskrankenhaus Salzburg, Paracelsus Medical University

,

Stefan Tino Kulnik

⁹Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria

¹⁰Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, United Kingdom

,

Klaus Katzensteiner

⁶Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria

,

Iris Leister

¹¹Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, Austria

¹²Spinal Cord Injury and Tissue Regeneration Center Salzburg(SCI-TReCS), Paracelsus Medical University, Salzburg, Austria

› Institutsangaben

Abstract

Background Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee.

Methods Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases.

Results Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were “normal” in 15 and 14 patients, “nearly normal” in 11 and 7 patients, and “abnormal” in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test.

Conclusions Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.

Zusammenfassung

Hintergrund Die Rekonstruktion des vorderen Kreuzbandes (VKB) nach Ruptur wurde in den letzten Jahrzehnten als der Goldstandard der operativen Versorgung angesehen. Anatomische Studien haben gezeigt, dass das VKB prinzipiell ein Potenzial zur Heilung hat, und durch neuere Implantate, Operationstechniken und Fixationsmethoden haben kreuzbanderhaltende Techniken in den letzten Jahren wieder einen Aufschwung erlebt. Ziel der Studie war es, klinische, funktionelle und radiologische Ergebnisse nach Kreuzbandruptur 12–18 Monate nach kreuzbanderhaltender Versorgung mittels Internal-Brace-Technik bzw. nach Rekonstruktion mittels All-inside-Technik unter Verwendung eines Hamstring-Transplantats zu erheben.

Methodik Es wurden 50 Patient*innen (23 männlich, 27 weiblich) im Alter von 34,73 (10,8) mean (SD) Jahren 12–18 Monate nach chirurgischer Versorgung untersucht. Davon wurden 27 Patient*innen mittels Internal Brace kreuzbanderhaltend versorgt, 23 erhielten eine Kreuzbandrekonstruktion unter Verwendung eines autologen Hamstring-Transplantats. Folgende klinische Untersuchungen wurden standardisiert durchgeführt: Erfassung der Kniebeweglichkeit, Varus- und Valgusstress, Pivot-shift-Test. Die Translation der Tibia nach anterior wurde mittels KT-1000 gemessen. In beiden Gruppen wurden klinische subjektive Scores erhoben (IKDC, WOMAC, SF-36, KOOS, Lysholm). Eine Magnetresonanzuntersuchung wurde bei allen eingeschlossenen Patient*innen mittels 1,5-Tesla-Gerät in axialer, koronarer und parasagittaler Schichtung durchgeführt.

Ergebnisse Das Zeitintervall von der Verletzung bis zur Versorgung reichte von einem Tag bis 2 Monate (16,04 (15,1) mean (SD) Tage; Median = 13,55 Tage). Die Ergebnisse der Nachuntersuchung 12–18 Monate nach erfolgter Operation zeigten keine signifikanten Unterschiede in den subjektiven Knie-Scores, den klinischen Untersuchungen sowie der radiologischen Untersuchung zwischen den beiden Gruppen. Die Gruppe, die mittels Internal-Brace-Kreuzbanderhalt versorgt wurde, zeigte eine signifikant höhere Tibiatranslation nach anterior (p = 0,009) im Vergleich zur Gruppe, die eine Kreuzbandrekonstruktion erhielt.

Schlussfolgerung Der Erhalt des eigenen Kreuzbandes mittels Internal-Brace-Technik kann 12–18 Monate nach Versorgung gute klinische und radiologische Ergebnisse aufweisen. Die subjektive Zufriedenheit der Patient*innen unterscheidet sich nicht von denen, welche mittels Kreuzbandersatzplastik versorgt wurden. Die Internal-Brace-Technik kann unter der Voraussetzung einer raschen Versorgung und guter Gewebequalität des Kreuzbandstumpfes eine Versorgungsoption darstellen mit dem Vorteil, dass eine Sehnenentnahmemorbidität verhindert werden kann und im Falle einer Re-Ruptur oder im Revisionsfall die Möglichkeit besteht, die ipsilaterale Semitendinosussehne zu verwenden. Evidenzlevel: Level III.

Key words

knee injuries - anterior cruciate ligament - return-to-sport

Schlüsselwörter

Knieverletzungen - vorderes Kreuzband

Volltext

Referenzen

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