title: [Ligament bracing--augmented primary suture repair in multiligamentous knee injuries].
abstract: OBJECTIVE
  Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation.
  
  
  METHODS
  Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury.
  
  
  METHODS
  Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance.
  
  
  METHODS
  Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization.
  
  
  METHODS
  Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks.
  
  
  RESULTS
  In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.
authors.affiliation: Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St.Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Heitmann
authors.forename: M
authors.initials: M
authors.lastname: Gerau
authors.forename: J
authors.initials: J
authors.lastname: Hötzel
authors.forename: A
authors.initials: A
authors.lastname: Giannakos
authors.forename: K-H
authors.initials: KH
authors.lastname: Frosch
authors.forename: A
authors.initials: A
authors.lastname: Preiss
mesh_terms: D000293:Adolescent; D000328:Adult; D001915:Braces; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D031221:Knee Dislocation / Q000473:pathology* / Q000601:surgery*; D007718:Knee Injuries / Q000473:pathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000473:pathology / Q000601:surgery; D011474:Prosthesis Design; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
vernacular_title: Ligament bracing--Augmentierte Primärnaht bei multiligamentären Verletzungen des Kniegelenks.