title: [Anatomic reconstruction of the anterior cruciate ligament with the autologous quadriceps tendon. Primary and revision surgery].
abstract: OBJECTIVE
  Restore function of the anterior cruciate ligament (ACL).
  
  
  METHODS
  Chronic functional instability with rupture of the ACL, giving way phenomena, acute rupture of the ACL with concomitant meniscus repair, rerupture of ACL graft with anatomical tunnels.
  
  
  METHODS
  Local infection of the skin at the knee joint, local soft tissue damage, after rupture of the quadriceps tendon, enthesopathia of the quadriceps tendon, lack of patient compliance.
  
  
  METHODS
  Harvest quadriceps tendon graft with a bone block via a 4-5 cm long incision, starting from the middle third of the proximal patella pole without damaging the tendon fibers. Drill the femoral tunnel via a deep anteromedial portal with the knee flexed of more than 110° (tunnel diameter 0.5-1 mm smaller in diameter than bone block). Gentle tunnel preparation using dilators. In absence of an ACL stump the lateral meniscus anterior horn serves as tibial landmark. In case of revision surgery, remove graft material and implants from the tunnel. Graft fixation using press fit method in the femoral tunnel. Tibial graft fixation archieved with a resorbable interference screw and a button.
  
  
  METHODS
  Goal of the inflammatory phase (weeks 1-2) is pain and inflammation control (20 kg partial weight bearing). During the proliferative phase (weeks 2-6), load and mobility slowly increased (closed-chain exercises). During the remodeling phase (> 6 weeks), strength and coordination exercises are performed. In revision cases and in case of concomitant injuries, longer partial weight-bearing period might be necessary. Athletes should not return to competitive sports before 6-8 months.
  
  
  RESULTS
  In a prospective study, 33 patients (age 16-48 years) were examined after replacement of the ACL with a quadriceps tendon graft after a minimum follow-up (FU) of 2 years (12 revision; 21 primary surgery). No post- or perioperative complications. Postoperative radiographs showed an anatomical tunnel location and no dislocation of the bone block. After 2 years the difference of a-p translation compared to the other leg was assessed by the use of KT 1000. The revision group improved from an average of 7.2 mm (pre-op) to 2.2 mm (FU). The group with primary surgery improved from 6.4 mm (pre-op) to 1.7 mm (FU). A sliding pivot shift phenomenon was detected in 2 patients in the revision group and 1 patient in the primary surgery group.
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar Theyss Str. 27-31, 14 193, Berlin, Deutschland, ph.forkel@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Forkel
authors.forename: W
authors.initials: W
authors.lastname: Petersen
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
vernacular_title: Anatomische Ersatzplastik des vorderen Kreuzbandes mit der autologen Quadrizepssehne. Primär- und Revisionsoperation.