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Tibiale Press-fit-Fixierungen von Beugesehnen zur Rekonstruktion des vorderen Kreuzbandes

Tibial press-fit fixation of flexor tendons for reconstruction of the anterior cruciate ligament

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Zusammenfassung

Hintergrund

Die Verankerung von Hamstringtransplantaten zur Rekonstruktion des vorderen Kreuzbandes (VKB) mittels einer Press-fit-Fixation ist eine interessante Technik, da keine Implantate nötig sind. Ziel dieser Studie war es, die biomechanischen Eigenschaften von Press-fit-Fixationen zu charakterisieren und sie mit einer Interferenzschraubenfixation zu vergleichen.

Methoden

Für die Explantation der Semitendinosus- und Grazilissehnen (SG) wurden 28 Leichenknie verwendet. Ein zusätzlicher Knochenblock wurde medial der Tuberositas tibiae aus einem Bereich, in dem der tibiale Bohrkanal bei der VKB-Rekonstruktion angelegt wird, entnommen. Für die Verankerung im Bohrkanal wurden porcine Femora benutzt.

Ergebnisse

Die maximale Ausreißkraft der Press-fit-tape-Fixation lag bei 970±83 N, die Knochenbrückenfixation lag bei 572±151 N, die Interferenzschraubenfixation lag bei 544±109 N, die Press-fit-suture-Fixation lag bei 402±77 N und die Knochenblockfixation erreichte einen Wert von 290±74 N. Die maximale Ausreißkraft der T-Gruppe ist allen anderen Gruppen signifikant überlegen (p<0,001).

Schlussfolgerung

Diese Studie zeigt, dass eine tibiale Press-fit-Technik, die autologe Knochenblöcke verwendet, einer einfachen Interferenzschraubenfixation hinsichtlich ihrer maximalen Versagenslast überlegen ist.

Abstract

Background

Press-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation.

Methods

Twenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated.

Results

The maximum load to failure was 970±83 N for the press-fit tape fixation (T), 572±151 N for the bone bridge fixation (TS), 544±109 N for the interference screw fixation (I), 402±77 N for the press-fit suture fixation (S) and 290±74 N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001).

Conclusion

This study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.

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Danksagung

Die Autoren danken Herrn Reinhold Krentscher aus dem Institut für Rechtsmedizin der Medizinischen Hochschule Hannover für seine Hilfe.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    M. Ettinger, E. Liodakis, C. Haasper, C. Krettek & M. Jagodzinski

  2. Labor für Biomechanik und experimentelle Orthopädie, Abteilung für Orthopädie, Medizinische Hochschule Hannover, Hannover, Deutschland

    C. Hurschler

  3. Rechtsmedizinische Klinik, Medizinische Hochschule Hannover, Hannover, Deutschland

    D. Breitmeier

Authors
  1. M. Ettinger
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  2. E. Liodakis
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  3. C. Haasper
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  4. C. Hurschler
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  5. D. Breitmeier
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  6. C. Krettek
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  7. M. Jagodzinski
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Corresponding author

Correspondence to M. Ettinger.

Additional information

Teile dieser Arbeit sind bereits erschienen in Jagodzinski et al. (2010) Biomechanische Analyse der Press-fit-Fixierung von Kreuzbandtransplanaten. Unfallchirurg 113(7):532–539.

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Ettinger, M., Liodakis, E., Haasper, C. et al. Tibiale Press-fit-Fixierungen von Beugesehnen zur Rekonstruktion des vorderen Kreuzbandes. Unfallchirurg 115, 811–816 (2012). https://doi.org/10.1007/s00113-010-1944-z

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