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Arthroskopische VKB-Ersatzplastik mit BPTB-Transplantat in Press-fit-Technik

Arthroscopic anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft in press-fit technique

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Arthroskopie Aims and scope

Zusammenfassung

Die Rekonstruktion des vorderen Kreuzbands (VKB) mittels BPTB-Transplantat („bone patellar tendon bone graft“) hat v. a. für die Revisionschirurgie nach wie vor ihren Stellenwert.

Grundlage für die hier vorgestellte Operationstechnik ist die Transplantatentnahme mittels oszillierender Hohlsäge. Diese erlaubt eine standardisierte Entnahme zweier zylindrischer Knochenblöcke, welche an vorbestehende Bohrkanäle angepasst werden können. So wird auch für die Revisionschirurgie ein implantatfreies Verankern in Femur und Tibia mit hoher Primärstabilität ermöglicht.

Die Vorteile sind eine gelenknahe Fixation, die anatomiegerechte Ausrichtung des Transplantats, Vermeidung von Implantaten und durch Wiederauffüllung die Verhinderung von Bohrkanalausweitungen. In der Literatur finden sich bei den Langzeitergebnissen gute Resultate im Hinblick auf die Stabilität. Nachteile sind die höhere Entnahmemorbidität, schmerzhafterer postoperativer Verlauf und langfristig bestehende Probleme von Seiten des Streckapparats, insbesondere beim Knien

Abstract

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) with a bone-patellar tendon-bone autograft in the press-fit technique is an efficient procedure which provides high primary stability without the use of implants.

In cases of revision after failed ACL reconstruction with hamstrings the technique offers the advantage of a standardized graft harvest. The cylindrical bone plugs address preexisting bone void at femoral and tibial sites. The advantages of the described technique are the aperture fixation of the graft, anatomical orientation of the graft to restore the fibre length change behaviour and refilling of the tunnels to avoid bone tunnel enlargement especially on the tibial site.

Long-term results regarding joint stability are comparable to ACL repair using hamstrings. The disadvantages are higher morbidity due to graft harvest, higher rate of extensor mechanism problems and postoperative discomfort for the patient.

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  1. Abteilung für Unfallchirurgie, Krankenhaus der Barmherzigen Brüder Eisenstadt, Esterhazystr. 26, 7000, Eisenstadt, Österreich

    H. Boszotta

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  1. H. Boszotta
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Correspondence to H. Boszotta.

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Boszotta, H. Arthroskopische VKB-Ersatzplastik mit BPTB-Transplantat in Press-fit-Technik. Arthroskopie 26, 42–46 (2013). https://doi.org/10.1007/s00142-012-0716-x

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  • DOI: https://doi.org/10.1007/s00142-012-0716-x

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