Download PDF
Osteosynthese International 2001; 9(1): 31-35
DOI: 10.1055/s-2001-16153
Originalarbeit

J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG

Die arthroskopische tibiale und femorale Zweibündeltechnik des hinteren Kreuzbandersatzes

Arthroscopic double bundle reconstruction of the posterior cruciate ligamentG. Reif, F. Hoffmann
  • Klinik für Orthopädie und Sportorthopädie im Klinikum Rosenheim (Chefarzt: Dr. F. Hoffmann), Lehrkrankenhaus der Ludwig-Maximilians-Universität München
Further Information

Publication History

Publication Date:
31 December 2001 (online)

    Permissions and Reprints

Zusammenfassung

Wir stellen eine neue arthroskopische Technik des hinteren Kreuzbandersatzes in einer Zweibündeltechnik unter Verwendung der autologen vierfachen Semitendinosussehne und der gedoppelten Grazilissehne vor. Tibial und femoral werden jeweils zwei separate Bohrkanäle angelegt, um ein anterolaterales und ein posteromediales Bündel zu rekonstruieren. Die Fixation der Transplantate erfolgt femoral mit zwei Endobuttons, tibial mittels suture disc und Staples.

Arthroscopic double bundle reconstruction of the posterior cruciate ligament

Summary

We present a new arthroscopic, all-inside double bundle technique of posterior cruciate ligament reconstruction using the autologous quadrupled semitendinosus and the doubled gracilis tendon. Two separate bone tunnels were drilled at the tibial and femoral side in order to reconstuct the anterolateral and the posteromedial bundle. The fixation of the grafts was performed by two Endobuttons at the femoral and suture disc/staples at the tibial side.

Résumé

Nous présentons une nouvelle technique arthroscopique de remplacement du ligament croisé postérieur avec utilisation du tendon autologue quadruplé du demi-tendineux et du tendon du m. gracilis doublé.
Deux carreaux sont creusés à chaque niveau tibial et fémoral afin de reconstruire un faisceau antéro-latéral et un faisceau postéro-médial. La fixation des transplants est assurée au niveau fémoral par deux Endobutton, au niveau tibial par suture-disc et agrafes.

Resumen

Presentamos una nueva técnica artroscópica de reconstrucción del ligamento cruzado posterior, del tipo todo por dentro con doble banda, usando el semitendinoso autólogo cuadruplicado y el tendón del gracilis duplicado. Se perforan dos túneles separados en la tibia y el fémur para reconstruir las bandas anterolateral y pósteromedial. La fijación de los injertos se efectúa mediante dos endobotones en el fémur y sutura con discos/grampas en la tibia.

Schlüsselwörter

Hinterer Kreuzbandersatz - Arthroskopie - Doppelbündeltechnik - Kniebeugesehnen

Key words

PCL replacement - arthroscopy - double bundle technique - Hamstrings

Mots clés

Plastie du ligament croisé postérieur - arthroscopie - technique du double faisceau - tendons fléchisseurs du genou

Palabras claves

Reemplazo del ligamento cruzado posterior - artroscopía - técnica de la doble banda - músculos de la pata de ganso

Literatur

  • 1 Barrett G R, Savoie F H. Operative management of acute PCL injuries with associated pathology: Long-term results.  Orthopedics. 1991;  14 687-692
    PubMedSearch in Google Scholar
  • 2 Boynton M D, Tietjens B R. Long-term follow-up of the untreated isolated posterior cruciate ligament-deficient knee.  Am J Sports Med. 1996;  24 306-310
    CrossrefPubMedSearch in Google Scholar
  • 3 Buess E, Imhoff A, Hodler J, Rodriguez M. Hintere Kreuzbandruptur - Resultate, Arthrosebildung und MR-Befunde nach primärer und sekundärer operativer Behandlung.  Arthroskopie. 1993;  6 218-227
    PubMedSearch in Google Scholar
  • 4 Clancy W G, Shelbourne K D, Zoellner G B, Keene J S, Reider B, Rosenberg T D. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament.  J Bone Joint Surg [Am]. 1983;  65 310-322
    PubMedSearch in Google Scholar
  • 5 Clancy W G. Repair and reconstruction of the posterior cruciate ligament. In: Chapman M (Ed). Operative Orthopaedics. Lippincott, Philadelphia 1988; 1651-1665
  • 6 Clancy W G, Smith L. Arthroscopic anterior and posterior cruciate ligament reconstruction technique.  Ann Chir Gynaecol. 1991;  80 141-148
    PubMedSearch in Google Scholar
  • 7 Covey D C, Sapega A A. Current concepts review: Injuries of the posterior cruciateigament.  J Bone Joint Surg [Am]. 1993;  75 1376-1386
    PubMedSearch in Google Scholar
  • 8 Cross M J, Powell J F. Long-term follow up of posterior cruciate ligament rupture: a study of 116 cases.  Am J Sports Med. 1984;  12 292-297
    CrossrefPubMedSearch in Google Scholar
  • 9 Dandy D J, Pussey R J. The long term results of unrepaired tears of the posterior cruciate ligament.  J Bone Joint Surg [Br]. 1982;  64 92-94
    PubMedSearch in Google Scholar
  • 10 Fowler P J, Messieh S S. Isolated posterior cruciate ligament injuries in athletes.  Am J Sports Med. 1987;  5 553-557
    PubMedSearch in Google Scholar
  • 11 Friederich N F, Müller W, O'Brien W R. Klinische Anwendung biomechanischer und funktionell anatomischer Daten am Kniegelenk.  Orthopäde. 1992;  21 41-50
    PubMedSearch in Google Scholar
  • 12 Grood E S. Factors affecting the region of most isometric femoral attachments. Part I: The posterior cruciate ligament.  Am J Sports Med. 1989;  17 197-207
    CrossrefPubMedSearch in Google Scholar
  • 13 Hamner D L, Brown C H, Steiner M E, Hecker A T, Haye W C. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques.  J Bone Joint Surg [Am]. 1999;  81 549-557
    CrossrefPubMedSearch in Google Scholar
  • 14 Harner C D, Maday M G, Miller M D, Irrgang J J, Fu F H. Posterior cruciate ligament reconstruction using fresh-frozen allograft tissue: Indications, techniques, results and controversies. Scientific Exhibit 64th Annual meeting American Academy of Orthopaedic Surgeons, San Francisco, 18.- 23. Feb. 1993
  • 15 Hoffmann F, Haegele U. Transplantat-Knochen-Verbindung nach Augmentation des vorderen Kreuzbands durch die autologe Semitendinosussehne.  Arthroskopie. 1993;  6 164-168
    PubMedSearch in Google Scholar
  • 16 Hoffmann F. Offene versus arthroskopisch kontrollierte hintere Kreuzbandrekonstruktion - Vorteile der arthroskopischen Technik. In: Kohn D, Wirth CJ (Hrsg). Arthroskopische versus offene Operationen. Enke, Stuttgart 1994
  • 17 Hoffmann F, Reif G, Weis H. Arthroscopically assisted reconstruction of PCL-deficient knees. Abstractbook 7th Congress of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy. Budapest. Sicop Verlag, Bischheim 1996; 217
  • 18 Insall J N, Hood R W. Bone-block transfer of the medial head of the gastrocnemius for posterior cruciate ligament insufficiency.  J Bone Joint Surg [Am]. 1982;  64 691-699
    PubMedSearch in Google Scholar
  • 19 Jackson D W, Proctor C S, Simon T M. Arthroscopic assisted PCL reconstruction: A technical note on potential neurovascular injury related to drill bit configuration.  Arthroscopy. 1993;  9 224-227
    PubMedSearch in Google Scholar
  • 20 Jones R C, Richardson A B. Gore-Tex posterior cruciate ligament replacement - preliminary clinical results.  Orthop Trans. 1990;  14 123-124
    PubMedSearch in Google Scholar
  • 21 Keller P M, Shelbourne K D, McCarroll J R, Rettig A C. Nonoperatively treated isolated posterior cruciate ligament injuries.  Am J Sports Med. 1993;  21 132-136
    CrossrefPubMedSearch in Google Scholar
  • 22 Kennedy J C, Grainger R N. The posterior cruciate ligament.  J Trauma. 1967;  7 367-377
    CrossrefPubMedSearch in Google Scholar
  • 23 Kim S-J, Min B-H. Arthroscopic intraarticular interference screw technique of posterior cruciate ligament reconstruction: One-incision technique.  Arthroscopy. 1994;  10 319-323
    PubMedSearch in Google Scholar
  • 24 Lipscomb A B, Anderson A F, Norwig E D, Hovis W D, Brown D L. Isolated posterior cruciate ligament reconstruction - Long-term results.  Am J Sports Med. 1993;  21 490-496
    PubMedSearch in Google Scholar
  • 25 Lobenhoffer P, Gögüs A, Koch H. Hinterer Kreuzbandersatz und Bizepstenodese nach Clancy - Technik und Ergebnisse.  Orthopäde. 1993;  22 414-420
    PubMedSearch in Google Scholar
  • 26 Mathiak G, Wening J V, Jungbluth K H. Untersuchungen mit dem KT-1000-Kniearthrometer bei Verletzungen des hinteren Kreuzbandes im Vergleich zu Streßröntgenaufnahmen im Scheuba-Halteapparat.  Unfallchirurgie. 1995;  21 118-123
    PubMedSearch in Google Scholar
  • 27 Miller M D, Olszewski A D. Cruciate ligament graft intra-articular distances.  Arthroscopy. 1997;  13 291-295
    PubMedSearch in Google Scholar
  • 28 Morgan C D, Kalman V R, Grawl D M. The anatomic origin of the posterior cruciate ligament: Where is it? Reference landmarks for PCL reconstruction.  Arthroscopy. 1997;  13 325-331
    PubMedSearch in Google Scholar
  • 29 Nebelung W, Becker R, Merkel M, Röpke M. Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side.  Arthroscopy. 1998;  14 810-815
    CrossrefPubMedSearch in Google Scholar
  • 30 Noyes F R, Barber-Westin S K. Treatment of complex injuries involving the posterior cruciate and posterolateral ligaments of the knee.  Am J Knee Surg. 1996;  9 200-214
    PubMedSearch in Google Scholar
  • 31 Ochi M, Murao T, Sumen Y, Kobayashi K, Adachi N. Isolated posterior cruciate ligament insufficiency induces morphological changes of anterior cruciate ligament collagen fibrils.  Arthroscopy. 1999;  15 292-296
    PubMedSearch in Google Scholar
  • 32 Odensten M, Gillquist J. Reconstruction of the posterior cruciate ligament using a new drill-guide.  Knee Surg Sports Traumatol Arthroscopy. 1993;  1 39-43
    CrossrefPubMedSearch in Google Scholar
  • 33 Ogata K. Posterior cruciate ligament reconstruction: a comparative study of two different methods.  Bull Hosp Joint Dis. 1991;  51 186-198
    PubMedSearch in Google Scholar
  • 34 Ogata K, McCarthy J A. Measurements of length and tension patterns during reconstruction of the posterior cruciate ligament.  Am J Sports Med. 1992;  20 351-355
    PubMedSearch in Google Scholar
  • 35 Parolie J M, Bergfeld J A. Long term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete.  Am J Sports Med. 1989;  14 35-38
    PubMedSearch in Google Scholar
  • 36 Patel D V, Al-Duri Z, Aichroth P M. Gore-Tex prosthetic ligament reconstruction for chronic posterior cruciate instability of the knee. In: Aichroth PM, Cannon WD (Eds). Knee surgery - current practice. Deutscher Ärzte-Verlag, Köln 1992; 337-341
  • 37 Paulos L E, Nisbet J K. Chronic posterior cruciate ligament instability. In: Aichroth PM, Cannon WD (Eds). Knee surgery - current practice. Deutscher Ärzte-Verlag, Köln 1992; 342-352
  • 38 Petermann J, Gotzen L, Trus P. Wiederherstellende Eingriffe am hinteren Kreuzband - Experimentelle Untersuchungen zur Isometrie. Teil II: Untersuchungen am HKB-Ersatzmodell.  Unfallchirurg. 1992;  95 354-357
    PubMedSearch in Google Scholar
  • 39 Pinczewski L A, Thuresson P, Otto D, Nyquist F. Arthroscopic posterior cruciate ligament reconstruction using four-strand hamstring tendon graft and interference screws.  Arthroscopy. 1997;  13 661-665
    PubMedSearch in Google Scholar
  • 40 Poynton A R, Javadpour S M, Finegan P J, O'Brien M. The meniscofemoral ligaments of the knee.  J Bone Joint Surg [Br]. 1997;  79 327-330
    PubMedSearch in Google Scholar
  • 41 Roth J H, Bray R C, Best T M, Cunning L A, Jacobson R P. Posterior cruciate ligament reconstruction by transfer of the medial gastrocnemius tendon.  Am J Sports Med. 1988;  16 21-28
    PubMedSearch in Google Scholar
  • 42 Schaefer R K, Jackson D W. Arthroscopic management of the cruciate ligaments. In: McGinty JB (Ed). Operative arthroscopy. Raven Press, New York 1991; 389-416
  • 43 Shino K, Horibe S, Nakata K, Hamada M, Nakamura N. Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes.  J Bone Joint Surg [Br]. 1995;  77 895-900
    PubMedSearch in Google Scholar
  • 44 Shino K, Nakagawa S, Nakamura N, Matsumoto N, Toritsuka Y, Natsu-ume T. Arthroscopic posterior cruciate ligament reconstruction using hamstring tendons: One-incision technique with Endobutton.  Arthroscopy. 1996;  12 638-642
    PubMedSearch in Google Scholar
  • 45 Skyhar M J, Warren R F, Ortiz G J, Schwartz E, Otis J C. The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee.  J Bone Joint Surg [Am]. 1993;  75 694-699
    PubMedSearch in Google Scholar
  • 46 Tillberg B. The late repair of torn cruciate ligaments using menisci.  J Bone Joint Surg [Br]. 1977;  59 15-19
    PubMedSearch in Google Scholar
  • 47 Trus P, Gotzen L, Petermann J. Wiederherstellende Eingriffe am hinteren Kreuzband - Experimentelle Untersuchungen zur Isometrie. Teil I: Untersuchungen am Fadenmodell.  Unfallchirurg. 1992;  95 349-353
    PubMedSearch in Google Scholar
  • 48 Wirth C J, Jäger M. Dynamic double tendon replacement of the posterior cruciate ligament.  Am J Sports Med. 1984;  12 39-43
    PubMedSearch in Google Scholar

Dr. F. Hoffmann

Klinik für Orthopädie und
Sportorthopädie Rosenheim

Pettenkoferstraße 10

D-83022 Rosenheim

Phone: Tel.: + 49-80 31/36 34 01

Phone: Fax: + 49-80 31/36 49 28

Email: e-mail: frank.hoffmann@klinikum.rosenheim.org