Zusammenfassung
Studienziel: Bei Kindern und Jugendlichen wird in Deutschland eine ansteigende Zahl von vorderen Kreuzbandverletzungen diagnostiziert. Wegen der offenen Wachstumsfugen erfolgt die Stabilisierung oftmals erst verzögert. Bleiben die Patienten in dieser Zeit sportlich aktiv, werden zu einem hohen Anteil sekundäre Meniskus- und Knorpelverletzungen festgestellt. In einer retrospektiven Studie wurden unsere klinischen Ergebnisse nach vorderem Kreuzbandersatz im Kinder- und Jugendalter erfasst. Material und Methode: Bei 55 Patienten wurde das vordere Kreuzband mit einem 4‐fach-Hamstring-Graft in transepiphysärer Technik ersetzt. Die Fixation erfolgte rein extrakortikal mit Button (femoral) und Suture Washer oder Staple (tibial). Die Patienten waren zum Zeitpunkt der Operation im Durchschnitt 13 Jahre alt (8–16 Jahre). Ergebnisse: Die Nachuntersuchung erfolgte durchschnittlich nach 3,2 Jahren (1–7,5 Jahren). Im objektiven IKDC-2000-Score wurden 90,7 % als normal oder nahezu normal gewertet. Im Lysholm-Score wurden durchschnittlich 94,1 Punkte (70–100) erzielt und 93,9 Punkte (76–100) im Cincinnati-Knee-Score. 88 % der Patienten erreichten ihr Sportniveau exakt oder nahezu exakt wieder (Tegner-Score). Die Stabilitätsmessung mittels KT-1000 Arthrometer ergab eine Besserung von präoperativ durchschnittlich 5,8 mm (2–10 mm) auf 1,0 mm (0–4 mm). In drei Fällen (5,5 %) kam es zu einer VKB-Insuffizienz nach erneutem Trauma, wobei eine erneute Stabilisierung notwendig wurde. In zwei weiteren Fällen wurde eine Partialruptur des Transplantats festgestellt. Wachstumsstörungen oder eine Komplikation durch Verletzung der Epiphysenfugen traten in keinem Fall auf. Schlussfolgerung: Das angewandte Verfahren zeigte gute klinische Ergebnisse nach VKB-Rekonstruktion und stellt möglicherweise die Methode der Wahl bei jungen Patienten dar. Die Komplikationsrate ist gering. Bei keinem Patienten traten Wachstumsstörungen auf.
Abstract
Aim: The treatment of choice for skeletally immature patients with anterior cruciate ligament (ACL) deficiency is an ACL reconstruction. In a retrospective study we analysed the clinical results after ACL reconstruction in skeletally immature patients. Material and Method: In 55 immature patients the ACL was replaced with a four strand-hamstring graft in an anatomic transepiphyseal origin. The fixation was by means of an extracortical button femoral and a suture washer or staple tibial. Patient mean age at operation was 13 years (8 to 16 years). Results: The mean follow-up was at 3.2 years (1 to 7.5 years) postoperatively. The objective IKDC 2000 score was 90.7 % normal or almost normal values. The mean Lysholm score was 94.1 points (70–100), the mean Cincinnati knee score was 93.9 points (76–100) and 88 % of the patients went back to normal or almost normal sports according to the Tegner score. Stability testing performed with the KT-1000 arthrometer was 1.0 mm (0–4 mm) (preoperative average 5.8 mm). The traumatic re-rupture rate was 5.5 %. In two additional cases a partial rupture of the graft was analysed by arthroscopy. Growth deformities or leg length differences were not seen in any case. Conclusion: ACL reconstruction with hamstrings and extracortical fixation showed good results and might be the treatment of choice in immature patients. The complication rate was low and there were no postoperative growth deformities.
Schlüsselwörter
vordere Kreuzbandruptur - offene Wachstumsfugen - Hamstringsehnen - extrakortikale Fixation - Kreuzbandrekonstruktion
Key words
anterior cruciate ligament rupture - open physes - hamstrings - extracortical fixation - anterior cruciate ligament reconstruction
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Dr. Axel Marx
Orthopädie
Arcus Sportklinik
Rastatter Straße 17–19
75179 Pforzheim
Fax: 0 72 31/6 05 56 30 44
Email: axel@marx.eu
