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Aktuelle Traumatol 2004; 34(5): 207-212
DOI: 10.1055/s-2004-821097
Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Langzeitergebnisse nach primärer Bandersatzplastik des vorderen Kreuzbandes mit dem mittleren Patellasehnendrittel

Long-term Results after Primary Reconstruction of Anterior Cruciate Ligament using Mid-third Patellar Tendon AutograftC. Eberhardt1 , T. Böhme1 , A. H. Kurth1 , A. Jäger1
  • 1Orthopädische Universitäts- und Poliklinik Friedrichsheim, Frankfurt (Ärztlicher Direktor: Prof. Dr. med. L. Zichner)
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Publikationsverlauf

Publikationsdatum:
23. September 2004 (online)

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Zusammenfassung

Die vorliegende retrospektive Studie zeigt Langzeitergebnisse bei primärer Bandersatzplastik des vorderen Kreuzbandes mit dem mittleren Patellasehnendrittel durchschnittlich fast zehn Jahre nach erfolgter operativer Versorgung. Insgesamt konnten 39 Patienten mit einem Durchschnittsalter von 37,1 Jahren über einen mittleren Zeitraum von 116,7 Monaten nachuntersucht werden. Die Beurteilung der Kniegelenksstabilität erfolgte mittels Lachmann- und Pivot-shift-Test und zeigte bei 79,5 % stabile Gelenkverhältnisse. Eine zusätzliche Objektivierung durch eine KT-1000-Arthrometer-Messung erbrachte eine mittlere Differenz im Seitenvergleich von 1,7 mm, bei 69,2 % der Gelenke betrug die Seitendifferenz hierbei unter 2 mm. Die erhobenen klinischen Scorewerte zeigten exzellente Ergebnisse, der mittlere Lysholm-Score lag bei 93,7, im Tegner-Activity-Score konnten 87,2 % der Patienten ihr altes Leistungsniveau vor der Verletzung erreichen. Im IKDC-Score wurden 89,7 % der Gelenke als normal (A) oder fast normal (B) beurteilt. Die subjektive Patienteneinschätzung zur Kniegelenksfunktion lag mit 94,9 % normal oder fast normal bewerteten Gelenken noch darüber, was eine hohe subjektive Zufriedenheit der Patienten mit dem langfristigen Operationsergebnis zum Ausdruck bringt. Die Progression der Osteoarthrose auf der IKDC-Skala zeigte bei 23,1 % eine Zunahme radiologischer Arthrosezeichen, in 7,7 % Zeichen einer fortgeschrittenen Osteoarthrose (Grad C). Die statistische Aufarbeitung erbrachte hierbei eine signifikante Korrelation (p < 0.05) zwischen Progression der Osteoarthrose und einer Seitendifferenz von mehr als 2 mm in der KT-1000-Arthrometer-Messung. Die Rekonstruktion des vorderen Kreuzbandes mit einem autologen Transplantat des mittleren Patellasehnendrittels erbringt gute bis sehr gute Resultate hinsichtlich Stabilität, klinischer Funktion und subjektiver Patientenzufriedenheit. Ob die beobachtete Progression radiologischer Arthrosezeichen in einem Teil der Gelenke im weiteren Verlauf zu einer nachweislichen Verschlechterung der funktionellen klinischen Ergebnisse und Reduktion der hohen subjektiven Zufriedenheit der Patienten führt, muss im Rahmen weiterer Verlaufsbeobachtungen geklärt werden.

Abstract

The present study reveals long-term results in anterior cruciate ligament reconstruction using bone-tendon-bone autograft of the mid third patellar ligament ten years after surgical treatment. A total number of 39 patients with a mean age of 37.1 years was followed for an average of 116.7 month. Stability of the knee was evaluated using Lachmann and Pivot shift test, 79.5 % of the knees were stable. An additional KT-1000 arthrometer measurement showed a mean side-to-side difference of 1.7 mm, in 69.2 % the difference was less than 2 mm. The evaluated knee score systems showed excellent results, mean Lysholm score was at 93.7, in Tegner activity score 87.2 % of the patients regained their pre-injury activity level. In IKDC grading 89.7 % of the knees were rated normal (A) or nearly normal (B) and asked for a personal assessment of their knee function 94.9 % of the patients rated A or B, expressing a high grade of satisfaction with the long-term outcome of surgical treatment. The postoperative course of osteoarthritis showed a deterioration on the IKDC scale in 23.1 %, in 7.7 % with signs of progressive osteoarthritis of grade C. A high significant correlation (p < 0.01) was detected for progression of osteoarthritis and laxity of reconstruction more than 2 mm in side-to-side difference in the KT-1000 measurement. Reconstruction of the anterior cruciate ligament using a bone-tendon-bone autograft of the patellar ligament leads to excellent long-term results in respect to joint stability, clinical function and subjective satisfaction of patients. If progression of radiographic signs of osteoarthritis in some of the knees will lead to marked deterioration of clinical function and high level of patient's satisfaction has to be subject to further clinical long-term trials.

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Dr. med. Christian Eberhardt

Orthopädische Universitäts- und Poliklinik Friedrichsheim

Marienburgstraße 2

60528 Frankfurt

Telefon: 069/6705-0

eMail: c.eberhardt@friedrichsheim.de