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Biomechanik des hinteren Kreuzbandes und der hinteren Instabilität

Biomechanics of the posterior cruciate ligament and posterior instability

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Das hintere Kreuzband (HKB) ist der primäre Stabilisator gegen die posteriore tibiale Translation. Die Faserbündel des HKB verhalten sich nicht isometrisch. Das kräftige anterolaterale (AL-)Bündel ist in 90° Beugung gespannt; das dünnere posteromediale (PM-)Bündel kommt in maximaler Streckung und maximaler Beugung unter Spannung. Als funktioneller Agonist zum HKB gilt der M. quadriceps; die ischiokruralen Muskeln wirken antagonistisch, indem sie die Tibia in Beugung in die hintere Schublade ziehen. Das hintere Kreuzband wirkt synergistisch zu den posterolateralen und -medialen Strukturen. In der posterolateralen Gelenkecke sichert das laterale Seitenband das Kniegelenk v. a. gegen das varische Aufklappen. Der M. popliteus ist als aktiver Innenrotator an der Rotationssicherung beteiligt. Der wichtigste passive Stabilisator gegen die Außenrotation ist das Lig. popliteofibulare. Da sich die Spannung des Bandes isometrisch verhält, kann es das Gelenk in verschiedenen Stellungen gegen die Außenrotation sichern. Die durch die posterolaterale Insuffizienz verursachte fehlende laterale Stabilisierung in der Frontalebene führt selbst bei gerader Beinachse unter Belastung zu einer funktionellen Varusfehlstellung der Gelenkpartner, die als Erklärung für die hohe Inzidenz degenerativer Schäden im medialen Kompartiment dienen kann. Auch die posteromediale Gelenkecke leistet einen wichtigen Beitrag zur Verhinderung der posterioren tibialen Translation.

Abstract

The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation. The different fibers of the PCL do not act isometrically. Indeed, the anterolateral bundle (AL) is tense in 90° of flexion, whereas the posteromedial bundle (PM) is tense in extension and in deep flexion angles beyond 120° of knee flexion. A functional agonist of the PCL is the quadriceps muscle. The ischiocrural muscles act as antagonists by pulling the tibia backwards in knee flexion. The PCL is supported by the posteromedial and posterolateral extra-articular structures. Posterolaterally, the lateral collateral ligament (LCL) is a restraint to varus forces. The popliteus muscle, in its function as an active internal rotator, supports the rotational stability of the knee. The most important passive stabilizer to external rotation is the popliteofibular ligament. Due to its isometric behavior, this ligament is a restraint to external rotation in different flexion angles. A deficiency of the posterolateral corner leads even in a straight axis to a functional varus deformity of the knee due to the lateral instability. This may be a reason for the high incidence of degenerative changes in the medial compartment. The posteromedial structures are restraints to the posterior tibial translation.

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  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum, Waldeyer-Straße 1, 48149 , Münster, Deutschland

    W. Petersen & T. Zantop

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Correspondence to W. Petersen.

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Petersen, W., Zantop, T. Biomechanik des hinteren Kreuzbandes und der hinteren Instabilität. Arthroskopie 19, 207–214 (2006). https://doi.org/10.1007/s00142-006-0358-y

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