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„Ligament bracing“ – die augmentierte Kreuzbandnaht

Biomechanische Grundlagen für ein neues Behandlungskonzept

Ligament bracing – augmented cruciate ligament sutures

Biomechanical studies of a new treatment concept

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Zusammenfassung

Hintergrund

Im Rahmen der akuten Kniegelenkluxation führt die Naht von rupturierten Kreuzbändern in ca. 80 % der Fälle zu guten klinischen Ergebnissen. Nachteile sind die geringe Primärstabilität sowie die oft beobachtete sekundäre Elongation der genähten Bänder. In der vorliegenden experimentellen Studie wird die mechanische Stabilität verschiedener Augmente, welche die Kreuzbandnähte additiv verstärken, mit der Primärstabilität der Kreuzbandplastik verglichen.

Hypothese

Das Konzept „ligament bracing“ mit transossärer Kreuzbandnaht und unterstützender Fadenaugmentation ist biomechanisch der Kreuzbandrekonstruktion überlegen und bietet eine ausreichende Primärstabilität zum Schutz der Naht während der vulnerablen Nachbehandlungsphase.

Material und Methoden

Untersucht wurden 42 porkine Kniegelenke in sieben Gruppen. Die Stabilität von vier verschiedenen Naht-/Augmentatkonstrukten wurde der Stabilität der Kreuzbandrekonstruktion mittels humaner Hamstring-Sehne gegenüber gestellt. Die Testung erfolgte in 1000 Zyklen mit 20–154 N Belastung in a.-p.-Translation und 60° Flexion. Hierbei wurden die Elongation und die maximale Versagenslast gemessen und dokumentiert.

Ergebnisse

Weder die Kreuzbandrekonstruktion (3,13 ± 1,65 mm; 362 ± 51 N), noch die augmentierte Naht (1,89–2,5 mm; 464–624 N) erreichten die Primärstabilität des intakten Kreuzbandes (0,63 ± 0,34 mm; 1012 ± 91 N). Im Vergleich zur Kreuzbandrekonstruktion zeigten alle vier augmentierten Kreuzbandnähte eine geringere Elongation im zyklischen Test sowie eine höhere maximale Versagenslast. Die alleinige Naht erzielte unbefriedigende Ergebnisse (6,79 ± 4,86 mm; 177 ± 73 N).

Schlussfolgerung

Die augmentierte Kreuzbandnaht zeigt eine signifikant höhere Primärstabilität als die isolierte Naht der Kreuzbänder sowie die Kreuzbandplastik mit Hamstring-Sehnen und Bioschraubenfixation. Das Konzept des „ligament bracing“ soll bei der Versorgung akuter multiligamentärer Kniegelenkverletzungen zukünftig Anwendung finden. Die klinischen Ergebnisse sind abzuwarten.

Abstract

Background

In the context of acute knee dislocations, suture repair of ruptured cruciate ligaments leads to good clinical results in 80% of cases. Disadvantages are low primary stability and subsequently secondary elongation of the sutured ligaments. In the present study, we compared primary stability of suture repair, reinforced by different suture augments, to cruciate ligament reconstruction.

Objective

The concept of ligament bracing with transosseous suture repair of the cruciate ligaments and additional suture augmentation is biomechanically superior to cruciate ligament reconstruction.

Material and methods

A total of 42 porcine knee joints divided into seven groups were examined. The stability of four different suture/augmentation combinations were compared to cruciate ligament reconstruction with human hamstring tendons. The investigational setup consisted of testing 1000 cycles with 20 N to 154 N load in a.-p. translation and 60° flexion. Elongation and load to failure were measured.

Results

Neither reconstruction (3.13 ± 1.65 mm; 362 ± 51 N) nor augmented suture repair (1.89–2.5 mm; 464–624 N) achieved the primary stability of the intact cruciate ligament (0.63 ± 0.34 mm, 1012 ± 91 N). In comparison to ligament reconstruction, all four augmented suture repairs showed minor elongation in the cyclic test and a higher load to failure. The isolated suture repair showed poor results (6.79 ± 4.86 mm, 177 ± 73 N).

Conclusion

Augmented suture repair provides significantly higher stability compared with isolated suture repair and reconstruction with hamstring tendons. The concept of ligament bracing could be a promising future treatment option in acute knee dislocations. Clinical results remain to be seen.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Heitmann, A. Dratzidis, M. Jagodzinski, P. Wohlmuth, C. Hurschler, K. Püschel, A. Giannakos, A. Preiss und K.H. Frosch geben an, dass kein Interessenkonflikt besteht. Die Fadenmaterialien, Implantate und die Abb. 5. wurden von der Fa. Arthrex zur Verfügung gestellt. Eine finanzielle Unterstützung erfolgte nicht.

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Authors and Affiliations

  1. Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St.Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland

    M. Heitmann, A. Giannakos, A. Preiss &  K.-H. Frosch

  2. Asklepios Proresearch, Hamburg, Deutschland

    M. Heitmann & P. Wohlmuth

  3. Abteilung für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    A. Dratzidis & M. Jagodzinski

  4. Labor für Biomechanik und Biomaterialien, Medizinische Hochschule Hannover, Hannover, Deutschland

    C. Hurschler

  5. Institut für Rechtsmedizin, Universitätsklinik Eppendorf, Hamburg, Deutschland

    K. Püschel

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  1. M. Heitmann
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  2. A. Dratzidis
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  3. M. Jagodzinski
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  4. P. Wohlmuth
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  5. C. Hurschler
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  6. K. Püschel
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  7. A. Giannakos
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  8. A. Preiss
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  9. K.-H. Frosch
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Correspondence to K.-H. Frosch.

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Heitmann, M., Dratzidis, A., Jagodzinski, M. et al. „Ligament bracing“ – die augmentierte Kreuzbandnaht. Unfallchirurg 117, 650–657 (2014). https://doi.org/10.1007/s00113-014-2563-x

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