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Z Orthop Unfall 2010; 148(3): 276-281
DOI: 10.1055/s-0029-1240737
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© Georg Thieme Verlag KG Stuttgart · New York

Vergleichende Studie nach vorderer Hamstring-Kreuzbandplastik mit RigidFix® (Pinfixation) und EndoButton® (Ankerfixation)

Comparative Study after Hamstring ACL Plasty with RigidFix® (Pin Fixation) and EndoButton® (Anchor Fixation)E. Basad1 , A. Kipper2 , O. A. Wüsten3 , H. Stürz1 , B. A. Ishaque1
  • 1Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen
  • 2Chirurgie, Evangelisches Krankenhaus, Gießen
  • 3Abteilung für Diagnostische Radiologie, Universitätsklinikum Gießen und Marburg, Standort Gießen
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Publication History

Publication Date:
19 February 2010 (online)

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Zusammenfassung

Studienziel: Im Rahmen einer prospektiven Fallgruppenanalyse wurde der Vergleich zwischen einer Pinfixation mit RigidFix (RF) und einer Ankerfixation mit dem EndoButton (EB) mit Hamstrings angestellt. Methode: 67 Personen wurden präoperativ (t0) klinisch sowie nach 6 (t6) und 12 (t12) Monaten postoperativ klinisch und kernspintomografisch untersucht. In einer Gruppe (21 Fälle) wurde der EB als Vertreter der gelenkfernen extrakortikalen Verankerung gewählt. In der 2. Gruppe (46 Fälle) wurde eine gelenknahe Fixation mittels RF angewendet. Klinisch wurden KT-1000-Stabilitätsmessung, IKDC-, Lysholm- und Tegner-Score ermittelt. Kernspinradiologisch wurden Reflux und Tunnel Widening (TW) untersucht. Ergebnisse: Die KT-1000-Werte waren bei t6 (EB: 2,1 ± 4,1 mm, RF: 1,0 ± 2,5 mm) etwas stabiler in der RF-Gruppe (leicht signifikant, p = 0,044) und glichen sich danach zu t12 an (EB: 0,5 ± 3,1 mm, RF 1,0 ± 2,4 mm). Der mediane Tegner-Score bei t6 (EB: 4,3 ± 1,2, RF 4,1 ± 1,7) und bei t12 (EB: 5,9 ± 1,8, RF 5,4 ± 2,0) war vergleichbar (p = 0,692). Der mittlere Lysholm-Score war bei t6 (EB: 90 ± 11, RF: 91 ± 8,9) und t12 (EB: 95 ± 7,5, RF: 95 ± 7,4) jeweils vergleichbar (p = 0,589). Das Gleiche galt für den Median des IKDC-Scores zu t6 (EB: II, RF III) und t12 (EB: II, RF III). In der Kategorie femoraler Reflux zeigten sich in der EB-Gruppe zu t6 „geringe Säume“, die sich aber zu t12 in „keinen Reflux“ zu der RF-Gruppe anglichen (p = 0,550). Ein Tunnel Widening ließ sich in keiner der beiden Gruppen feststellen. Schlussfolgerung: Die Vertreter zweier unterschiedlicher Fixationstechniken zeigten im 12-monatigen Zeitverlauf keinen Unterschied bei klinischen und MRT-radiologischen Ergebnissen. Diskrete Unterschiede im Reflux von Synovialflüssigkeit und KT-1000-Stabilität in den frühen Phasen weisen auf einen unterschiedlichen Einheilungsverlauf hin. Die Ergebnisse weisen auch darauf hin, dass eine gelenkferne Verankerung alleine nicht für das Auftreten eines TW verantwortlich gemacht werden kann.

Abstract

Aim: Within a prospective case group study, two hamstring fixation techniques, a pin fixation with RigidFix (RF) and an anchor fixation with EndoButton (EB), were compared. Method: 67 patients were followed clinically and by MRI preoperatively (t0), at six months (t6) and at twelve months (t12). In one group (N = 21), EB was used for representing a juxta-articular graft fixation. The second group (N = 46) with RF was used to represent the ab-articular fixation. KT-1000 stability measurement, IKDC, Lysholm and Tegner scores were used to determine the clinical outcomes. Reflux and tunnel widening (TW) were investigated by MRI. Results: The KT-1000 values were slightly more stable at t6 (EB: 2.1 ± 4.1 mm, RF: 1.0 ± 2.5 mm) in the RF group (p = 0.044) but equalised later at t12 (EB: 0.5 ± 3.1 mm, RF 1.0 ± 2.4 mm). The median Tegner score at t6 (EB: 4.3 ± 1.2, RF 4.1 ± 1.7) and t12 (EB: 5.9 ± 1.8, RF 5.4 ± 2.0) were comparable (p = 0.692). The mean Lysholm score at t6 (EB: 90 ± 11, RF: 91 ± 8.9) and t12 (EB: 95 ± 7.5, RF: 95 ± 7.4) was comparable in each group (p = 0.589). The same was valid in the median of the IKDC score at t6 (EB: II, RF III) and t12 (EB: II, RF III). The category “femoral reflux” showed slight minimal fringe in the EB group at t6 but aligned to “no reflux” together with the RF group at t12 (NS, p = 0.550). A tunnel widening was not detectable in either of the groups.

Schlüsselwörter

EndoButton - RigidFix - Tunnelerweiterung - ACL - MRT - Reflux - gelenknah - gelenkfern

Key words

EndoButton - RigidFix - tunnel‐widening - ACL - MRI - reflux - juxta‐articular - ab‐articular

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Dr. Erhan Basad

Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie
Universitätsklinikum Gießen und Marburg, Standort Gießen

Paul-Meimberg-Straße 3

35392 Gießen

Phone: 06 41/9 94 29 00

Fax: 06 41/9 94 29 99

Email: erhan.basad@ortho.med.uni-giessen.de

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