Summary
Goal of Surgery
Restoration of normal knee function.
Indications
Acute avulsion of the anterior cruciate ligament (ACL) from its femoral origin.
Contraindications
Mid substance and remote tears.
Positioning and Anaesthesia
Supine. Knee flexed, hip bent to 30°.
General or regional anaesthesia.
Surgical Technique
Step 1: Arthroscopy to confirm site of rupture, meniscus repair if necessary.
Step 2: Mobilisation of semitendinosus tendon, left attached distally.
Step 3: Mini-arthrotomy, securing of ACL stump with atraumatic suture.
Step 4: Transfer of ST-tendon through 5 mm drill holes through tibial head and lateral femoral condyle.
Step 5: Fixation of tendon and ACL-sutures with staple at the exit of the femoral drill hole.
Postoperative Management
Knee orthosis for 6 weeks, CPM, physiotherapy. ROM day 0–2: 0-10-10°; day 3–11: 0-0-60°, day 12–42: 0-0-90°. Increase of weight bearing 10 kg/week from operation date. Bicycling and running permitted 3 months post-op. Full sport activity after muscle power has reached that of opposite side. LMW heparin until full weight bearing.
Possible Complications
Thrombosis. Embolism. Infection. Failure of reconstruction. Osteoarthritis.
Results
During 1 year, 116 patients were operated. Follow-up after 42 to 57 months (average 52 months) included 95 patients (82%). Of these, 76 underwent full examination (average age 33 1/2 years, 20–49 years), 11 answered a questionnaire, 8 had suffered re-injury.
Average Lysholm score was 92 points (±13).
Tegner activity scale amounted to 7.2 points pre-injury, 7.1 points at follow-up.
Anterior translation (KT 1000 arthrometer testing at 89 N) was identical to opposite side in 25 patients, less than 2 mm in 14, up to 4 mm in 19, up to 6 mm in 15, more that 6 mm in 3 patients. Pivot shift was negative or trace 73 times, and positive in 3 patients. ROM was full in 54 patients, 17 times the flexion was limited up to 10°. Ten times extension lag was less than 5°, and twice between 5 and 10°.
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Literatur
Kirchmayr, L.: Zur Technik der Sehnennaht. Zbl. Chir. 40 (1917), 906–907.
Kühne, J.-H., V. Jansson, M. Zimmer, S. Branner: Kombinierte Verletzung von vorderem Kreuzband und medialem Seitenband des Knieglenks—Zwei bis Sechs-Jahres-Ergebnisse der operativen Behandlung. Unfallchirurgie 5 (1992), 295–303.
Lindemann, K.: Über den plastischen Ersatz der Kreuzbänder durch gestielte Sehnenverpflanzungen. Z. orthop. Chir. 75 (1950), 316–334.
Lysholm, J., J. Gillquist: Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Amer. J. Sports Med. 10 (1982), 150–154.
Pagnani, M. J., J. J. P. Warner, S. J. O'Brien, R. F. Warren: Anatomic considerations in harvesting the semitendinosus and gracilis tendons and a technique of harvest. Amer. J. Sports Med. 21 (1993), 565–571.
Shelbourne, K. D., J. H. Wilckens, A. Mollabashy, M. DeCarlo: Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Amer. J. Sports Med. 19 (1991), 332–336.
Steadman, J. R., R. W. Higgins: ACL injuries in the elite skier. In: Feagin, J. A. (ed.): The crucial ligaments. Ch. Livingstone, New York—Edingburgh— London—Melbourne 1988, p. 471–482.
Tegner, Y., J. Lysholm, J. Gillquist: Rating systems in the evaluation of knee surgeyr. Clin. Orthop. 198 (1985), 43–49.
Wirth, C. J., M. Jäger, M. Kolb: Die komplexe vordere Knie-Instabilität. Thieme, Stuttgart—New York 1984, S. 56–58.
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Kühne, JH., Krüger-Franke, M. & Refior, H.J. Die Rekonstruktion frischer vorderer Kreuzbandrupturen durch Naht und Semitendinosusaugmentation. Operat Orthop Traumatol 9, 37–47 (1997). https://doi.org/10.1007/s00064-006-0006-8
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DOI: https://doi.org/10.1007/s00064-006-0006-8