[Technical, material and biomechanical requirements for alloplastic replacement of the anterior cruciate ligament surgical technic].
Chronically instable knee-joints progressively draw to an arthrosis as a result of the irregular kinematic. Different operative techniques to replace the anterior cruciate ligament using exclusively autologous, homologous or heterologous grafts in all cases of chronic instabilities, but the primary sole suture of acute ACL injuries, too, didn't show long-term stable results in many cases. Recurrent ruptures were found first of all at the intraarticular edge of the femoral tunnel caused by permanent abrasions of the replacement. The reason why is the large angle of the ACL and each replacement respectively under motion. The question of what tissue could or should be used for renewed autogenous reconstructions in case of re-instabilities and after using bone-tendon-bone-mid-third patellar-tendon-grafts isn't yet been discussed to the end. Because of the fact that there is no isometric behaviour of the complete ACL but of a few fibres only depending on the position of the knee the complete reconstruction of the ACL is absolutely impossible, but only a partial substitute. The anatomically limited intraarticular joint-space (notch) confines the replacements in their dimension and endangers voluminous reconstructions by an impending impingement especially as a result of the immediately postoperative swelling of the transplants. The use of the mid-third-patellar-tendon-graft destroys a lot of proprioceptors and causes a partly loss of the neuromuscular balance previously impaired by the loss of the ACL including its receptors. In addition to this the still existing proprioceptors of the ligamentous stumps can be definitively destroyed by big tunnels. Each autologous graft passes a long-term transformation and at best achieves to 50% of the maximum stress capacity of an original ACL after two years. Resulting from these reasons synthetic and unlimited-ly available ligaments presented themselves to be used for ACL replacements. The Trevira-ligament of polyethylenetherephthalat (= TRE-VIRA HOCHFEST 730R) seems to be best qualified therefore at the present. It meets the material and technical requirements and makes allowance for all biomechanical knowledge. A modified over-the-top technique by arthroscopy or mini-arthrotomy (minimized operative trauma) enables the preservation of still existing ligamentous tissue on the one hand and guarantees the immediate postoperative functional therapy on the other hand. A recurrent instability independent of cause doesn't bring about a worse starting position for the following renewed stabilization and enables corrective operative techniques including the substitute of a ruptured synthetic ligament if required.
Richter
A
A
Chirurgische Abteilung, Hospital zum Heiligen Geist, Hagen.
Krudwig
W K
WK
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008422:Materials Testing; D019736:Prostheses and Implants; D012008:Recurrence; D012421:Rupture