Download PDF
OP-Journal 2013; 29(3): 221-227
DOI: 10.1055/s-0033-1360153
Georg Thieme Verlag KG Stuttgart · New York

Hinteres Kreuzband und posterolaterale Ecke

Arthroscopic Joint Reconstruction – Posterior Cruciate Ligament and Posterolateral Corner
Achim Preiss
,
Maximilian Heitmann
,
Jörg Hoetzel
,
Karl-Heinz Frosch
Further Information

Publication History

Publication Date:
07 May 2014 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Verletzungen des hinteren Kreuzbands können isoliert oder in Kombination mit anderen Bandverletzungen des Kniegelenks auftreten. Ursache ist meist ein direktes Anpralltrauma des ventralen Unterschenkels oder ein Sturz auf das gebeugte Knie. Isolierte hintere Kreuzbandrupturen können in der Regel konservativ mittels einer speziellen Orthese behandelt werden. Bei der hinteren Kreuzbandverletzung ist jedoch meist die posterolaterale Ecke zusätzlich verletzt. Solche kombinierten Bandverletzungen sollten einer operativen Therapie zugeführt werden. Hierbei erfolgt die arthroskopische Rekonstruktion des hinteren Kreuzbands sowie die offene oder minimalinvasive Rekonstruktion oder Augmentation des Seitenband- und Popliteuskomplexes. Die Nachbehandlung der operativ versorgten posterolateralen Instabilität sollte mittels PCL-Orthese erfolgen. Bewegungsübungen erfolgen in den ersten 6 Wochen nur in Bauchlage unter Quadrizepsanspannung. Mit der arthroskopischen hinteren Kreuzbandplastik und der posterolateralen Rekonstruktion können gute klinische Ergebnisse bei geringen Komplikationsraten erzielt werden.

Abstract

Injuries of the posterior cruciate ligament (PCL) occur as isolated or as combined knee ligament injuries. The main cause is a direct blunt trauma to the proximal tibia or a fall on the flexed knee. Isolated injuries show good clinical results after conservative treatment, while combined injuries, affecting the posterolateral corner additionally, should be operatively. treated Arthroscopic reconstruction of the PCL followed by an open or minimally invasive reconstruction or augmentation of the peripheral structures should be performed. Aftercare comprises 6 weeks of wearing a PCL brace and movement of the joint in the prone position with active quadriceps tension. Isolated bony avulsions of the posterior cruciate ligament should also be refixated to avoid dislocation and to gain early mobilisation. In such cases we suggest either arthroscopic or mini-open surgery. With arthroscopic PCL and posterolateral reconstruction good results with a low complication rate can be achieved.

 

  • Literatur

  • 1 Aglietti P, Giron F, Buzzi R et al. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg [Am] 2004; 86: 2143-2155
    PubMedGoogle Scholar
  • 2 Apsingi S, Nguyen T, Bull AM et al. Control of laxity in knees with combined posterior cruciate ligament and posterolateral corner deficiency: comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction combined with modified Larson posterolateral corner reconstruction. Am J Sports Med 2008; 36: 487-494
    PubMedGoogle Scholar
  • 3 Apsingi S, Nguyen T, Bull AM et al. The role of PCL reconstruction in knees with combined PCL and posterolateral corner deficiency. Knee Surg Sports Traumatol Arthrosc 2008; 16: 104-111
    CrossrefPubMedGoogle Scholar
  • 4 Chan YS, Yang SC, Chang CH et al. Arthroscopic reconstruction of the posterior cruciate ligament with use of a quadruple hamstring tendon graft with 3- to 5-year follow-up. Arthroscopy 2006; 22: 762-770
    CrossrefPubMedGoogle Scholar
  • 5 Chen CH. Surgical treatment of posterior cruciate ligament injury. Chang Gung Med J 2007; 30: 480-492
    Google Scholar
  • 6 Chen CH, Chen WJ, Shih CH et al. Arthroscopic posterior cruciate ligament reconstruction with quadriceps tendon autograft: minimal 3 years follow-up. Am J Sports Med 2004; 32: 361-368
    CrossrefPubMedGoogle Scholar
  • 7 Chen CH, Chuang TY, Wang KC et al. Arthroscopic posterior cruciate ligament reconstruction with hamstring tendon autograft: results with a minimum 4-year follow-up. Knee Surg Sports Traumatol Arthrosc 2006; 14: 1045-1054
    CrossrefPubMedGoogle Scholar
  • 8 Christel P. Basic principles for surgical reconstruction of the PCL in chronic posterior knee instability. Knee Surg Sports Traumatol Arthrosc 2003; 11: 289-296
    CrossrefPubMedGoogle Scholar
  • 9 Deehan DJ, Salmon LJ, Russell VJ et al. Endoscopic single-bundle posterior cruciate ligament reconstruction: results at minimum 2-year follow-up. Arthroscopy 2003; 19: 955-962
    CrossrefPubMedGoogle Scholar
  • 10 Freeman RT, Duri ZA, Dowd GS. Combined chronic posterior cruciate and posterolateral corner ligamentous injuries: a comparison of posterior cruciate ligament reconstruction with and without reconstruction of the posterolateral corner. Knee 2002; 9: 309-312
    CrossrefPubMedGoogle Scholar
  • 11 Frosch K, Proksch N, Preiss A et al. [Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach]. Oper Orthop Traumatol 2012; 24: 348-353
    CrossrefPubMedGoogle Scholar
  • 12 Geeslin AG, Laprade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg [Am] 2011; 93: 1672-1683
    PubMedGoogle Scholar
  • 13 Harner CD, Vogrin TM, Hoher J et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 2000; 28: 32-39
    PubMedGoogle Scholar
  • 14 Jung YB, Jung HJ, Kim SJ et al. Posterolateral corner reconstruction for posterolateral rotatory instability combined with posterior cruciate ligament injuries: comparison between fibular tunnel and tibial tunnel techniques. Knee Surg Sports Traumatol Arthrosc 2008; 16: 239-248
    CrossrefPubMedGoogle Scholar
  • 15 Laprade RF, Muench C, Wentorf F et al. The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft: a biomechanical study. Am J Sports Med 2002; 30: 233-238
    PubMedGoogle Scholar
  • 16 Mariani PP, Becker R, Rihn J et al. Surgical treatment of posterior cruciate ligament and posterolateral corner injuries. An anatomical, biomechanical and clinical review. Knee 2003; 10: 311-324
    CrossrefPubMedGoogle Scholar
  • 17 Markolf KL, Graves BR, Sigward SM et al. Popliteus bypass and popliteofibular ligament reconstructions reduce posterior tibial translations and forces in a posterior cruciate ligament graft. Arthroscopy 2007; 23: 482-487
    CrossrefPubMedGoogle Scholar
  • 18 Pacheco RJ, Ayre CA, Bollen SR. Posterolateral corner injuries of the knee: a serious injury commonly missed. J Bone Joint Surg [Br] 2011; 93: 194-197
    PubMedGoogle Scholar
  • 19 Schulz MS, Russe K, Weiler A et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003; 123: 186-191
    CrossrefPubMedGoogle Scholar
  • 20 Servant CT, Ramos JP, Thomas NP. The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury. Knee 2004; 11: 265-270
    CrossrefPubMedGoogle Scholar
  • 21 Shelbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med 2013; 41: 1526-1533
    CrossrefPubMedGoogle Scholar
  • 22 Strobel MJ, Weiler A. Therapie der chronischen HKB-Läsion. Arthroskopie 2006; 19: 243-257
    CrossrefPubMedGoogle Scholar
  • 23 Vogrin TM, Hoher J, Aroen A et al. Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2000; 8: 93-98
    CrossrefPubMedGoogle Scholar
  • 24 Wang CJ. Injuries to the posterior cruciate ligament and posterolateral instabilities of the knee. Chang Gung Med J 2002; 25: 288-297
    PubMedGoogle Scholar
  • 25 Wang CJ, Chen HS, Huang TW. Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear. Injury 2003; 34: 747-751
    CrossrefPubMedGoogle Scholar
  • 26 Yoon KH, Bae DK, Song SJ et al. A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med 2011; 39: 474-480
    CrossrefPubMedGoogle Scholar
  • 27 Yoshiya S, Nagano M, Kurosaka M et al. Graft healing in the bone tunnel in anterior cruciate ligament reconstruction. Clin Orthop Relat Res 2000; 278-286
    PubMedGoogle Scholar
  • 28 Zantop T. Begleitende Verletzungen des hinteren Kreuzbandes bei Femurschaftfrakturen. Joint German Congress of Orthopaedics and Trauma Surgery. Berlin: 2006
    Google Scholar
  • 29 Zantop T, Petersen W. [Modified Larson technique for posterolateral corner reconstruction of the knee]. Oper Orthop Traumatol 2010; 22: 373-386
    CrossrefPubMedGoogle Scholar