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Technik der Doppelbündelrekonstruktion

The double bundle reconstruction technique

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Ziel der Doppelbündelrekonstruktion ist der separate Ersatz des AM- und PL-Bündels des vorderen Kreuzbandes (VKB), um die komplexen mechanischen Eigenschaften des intakten VKB wieder herzustellen.

Die Anlage der femoralen Tunnel erfolgt über 2 mediale Portale (AM und PL). Durch die Verwendung von 2 Portalen kommt es zu einer Divergenz der femoralen Tunnel. Der Durchmesser des AM-Transplantats variiert zwischen 6 und 8 mm, des PL-Transplantats zwischen 5 und 6 mm. An der Tibia wird zuerst der AM-Tunnel in Höhe des Außenmeniskusvorderhorns angelegt, danach der PL-Tunnel, der 8–10 mm vor dem HKB liegen sollte. Die Fixation der Transplantate erfolgt am Femur extrakortikal („flip tack“). An der Tibia erfolgt eine Hybridfixation mittels resorbierbarer Interferenzschraube und Fixationsbutton.

Den biomechanischen Vorteilen der Doppelbündelrekonstruktion (bessere Rotationsstabilität und Stabilisierung in Streckstellung) stehen einige Nachteile gegenüber (doppeltes Risiko der falschen Tunnelanlage, erhöhte Gefahr der Fehlpositionierung, schwierige Revisionschirurgie).

Abstract

The aim of anatomic double bundle anterior cruciate ligament (ACL) reconstruction is the functional restoration of the anteromedial (AM) and posterolateral (PL) bundle of the ACL.

The femoral tunnels are drilled through two medial portals (AM and PL portal) to produce divergent tunnels. Tunnel diameter for the AM bundle varies between 6 und 8 mm (PL graft 5–6 mm). At the tibia, the AM tunnel is first drilled aligned with the anterior horn of the lateral meniscus. Afterwards, the PL tunnel is drilled PCL referenced. At the femur, extracortical fixation is performed with an extracortical button technique (flip tack). At the tibia, a hybrid fixation is performed with a biodegradable interference screw and a button.

The biomechanical advantages of ACL double bundle reconstruction (better rotational and AP stability) are counteracted by some disadvantages (double risk of tunnel misplacement, higher risk of tunnel misplacement, difficult revisions).

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Authors and Affiliations

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

    W. Petersen & T. Zantop

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  1. W. Petersen
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  2. T. Zantop
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Correspondence to W. Petersen.

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Petersen, W., Zantop, T. Technik der Doppelbündelrekonstruktion. Arthroskopie 20, 132–138 (2007). https://doi.org/10.1007/s00142-007-0389-z

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