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Z Orthop Unfall 2024; 162(03): 316-328
DOI: 10.1055/a-2091-4681
CME-Fortbildung

Therapie von Verletzungen des hinteren Kreuzbandes

Treatment of Injuries to the Posterior Cruciate Ligament
Alexander Korthaus
,
Sofia Hansen
,
Matthias Krause
,
Karl-Heinz Frosch
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Im Vergleich zu der vorderen Kreuzbandverletzung stellt die Ruptur des hinteren Kreuzbandes (HKB) die seltenere Erkrankung dar. Dem HKB wird in der Literatur ein hohes Heilungspotenzial zugeschrieben, daher wird neben der operativen Therapie auch der konservativen Therapie ein Stellenwert eingeräumt. Die hintere Kreuzbandruptur ist häufig mit Begleitverletzungen assoziiert. Unter anderem sind in bis zu 70% der Fälle Verletzungen der posterolateralen Ecke begleitend vorhanden. Die Detektion der Begleitverletzungen hat maßgeblichen Einfluss auf das Outcome, da in diesen Fällen die isolierte operative HKB-Stabilisierung nicht zu zufriedenstellenden Ergebnissen führt.

Abstract

Compared to the anterior cruciate ligament injury, the rupture of the posterior cruciate Ligament (PCL) is the rarer condition. A high healing potential is attributed to the PCL in the literature, which is why conservative therapy is also considered important in addition to surgical treatment [1]. Posterior cruciate ligament rupture is often associated with concomitant injuries. Among other things, up to 70% of cases are associated with accompanying injuries to the posterolateral corner [2]. The detection of concomitant injuries has a significant influence on the outcome, as isolated surgical PCL stabilization does not lead to satisfactory results in these cases.

Kernaussagen

  • Die konservative Therapie hat einen hohen Stellenwert bei isolierten Verletzungen des hinteren Kreuzbandes (HKB).

  • Die Detektion von Begleitverletzungen ist essenziell für einen Therapieerfolg.

  • Auch Avulsionsverletzungen des hinteren Kreuzbandes können abhängig von der Dislokation des Fragmentes mit guten klinischen Ergebnissen konservativ therapiert werden.

  • Die Rekonstruktion in Doppelbündeltechnik bietet keinen Outcome-Vorteil gegenüber der Einzelbündeltechnik.

  • Bei operativer Therapie der akuten HKB-Verletzung stellt das Ligament Bracing eine gute Alternative zur HKB-Plastik dar.

  • Die Indikation zur Slope-Korrektur mit Erhöhung des Slope sollte insbesondere bei chronischen Instabilitäten und versagter operativer Therapie in Betracht gezogen werden.

Schlüsselwörter

HKB-Ruptur - Kreuzbandruptur - Knieverletzung - hinteres Kreuzband

Keywords

cruciate ligament rupture - knee injury - posterior cruciate ligament


Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Winkler PW, Zsidai B, Wagala NN. et al. Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biomechanics and diagnostics. Knee Surg Sports Traumatol Arthrosc 2021; 29: 672-681
    CrossrefPubMedSuche in Google Scholar
  • 2 Schulz MS, Russe K, Weiler A. et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003; 123: 186-191
    CrossrefPubMedSuche in Google Scholar
  • 3 Schlumberger M, Schuster P, Eichinger M. et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc 2020; 28: 2091-2098
    CrossrefPubMedSuche in Google Scholar
  • 4 Pearsall AW, Hollis JM. The effect of posterior cruciate ligament injury and reconstruction on meniscal strain. Am J Sports Med 2004; 32: 1675-1680
    CrossrefPubMedSuche in Google Scholar
  • 5 Strobel MJ, Weiler A, Schulz MS. et al. Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. Arthroscopy 2003; 19: 262-268
    CrossrefPubMedSuche in Google Scholar
  • 6 Harner CD, Hoher J. Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998; 26: 471-482
    CrossrefPubMedSuche in Google Scholar
  • 7 Strobel MJ, Weiler A. Therapie der chronischen HKB-Läsion. Arthroskopie 2006; 19: 243-257
    CrossrefPubMedSuche in Google Scholar
  • 8 Sudasna S, Harnsiriwattanagit K. The ligamentous structures of the posterolateral aspect of the knee. Bull Hosp Jt Dis Orthop Inst 1990; 50: 35-40
    PubMedSuche in Google Scholar
  • 9 Strobel M, Stedtfeld HW, Eichhorn HJ. Diagnostik des Kapsel-Band-Apparates. In: Strobel M, Stedtfeld HW, Eichhorn HJ. Diagnostik des Kniegelenkes. Berlin: Springer; 1995: 132-218
    Suche in Google Scholar
  • 10 Wachowski M. Deutsche Gesellschaft für Unfallchirurgie (DGU). Leitlinie Hintere Kreuzbandruptur, 2018. Zugriff am 18. April 2024 unter: https://register.awmf.org/assets/guidelines/012–029l_S1_Hintere-Kreuzbandruptur_2018–08_02.pdf
    PubMed
  • 11 Frings J, Akoto R, Müller G. et al. Bony avulsions of the posterior cruciate ligament: arthroscopic or minimally invasive?. Arthroskopie 2018; 31: 52-58
    CrossrefPubMedSuche in Google Scholar
  • 12 White EA, Patel DB, Matcuk GR. et al. Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol 2013; 20: 429-440
    CrossrefPubMedSuche in Google Scholar
  • 13 Yoon KH, Kim SG, Park JY. The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc 2021; 29: 1269-1275
    CrossrefPubMedSuche in Google Scholar
  • 14 Mehl J, Breulmann FL, Siebenlist S. Akute Verletzungen des hinteren Kreuzbands. Orthopädie Rheuma 2023; 26: 20-28
    CrossrefPubMedSuche in Google Scholar
  • 15 Wang SH, Chien WC, Chung CH. et al. Long-term results of posterior cruciate ligament tear with or without reconstruction: a nationwide, population-based cohort study. PLoS One 2018; 13: e0205118
    CrossrefPubMedSuche in Google Scholar
  • 16 Agolley D, Gabr A, Benjamin-Laing H. et al. Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries: medium-term follow-up. Bone Joint J 2017; 99-B: 774-778
    CrossrefPubMedSuche in Google Scholar
  • 17 Bedi A, Musahl V, Cowan JB. Management of posterior cruciate ligament injuries: an evidence-based review. J Am Acad Orthop Surg 2016; 24: 277-289
    CrossrefPubMedSuche in Google Scholar
  • 18 Berg EE. Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 1995; 11: 69-76
    CrossrefPubMedSuche in Google Scholar
  • 19 Panchal HB, Sekiya JK. Open tibial inlay versus arthroscopic transtibial posterior cruciate ligament reconstructions. Arthroscopy 2011; 27: 1289-1295
    CrossrefPubMedSuche in Google Scholar
  • 20 Lee SH, Jung YB, Rhee SM. et al. Revision posterior cruciate ligament reconstruction with a modified tibial-inlay double-bundle technique. JBJS Essent Surg Tech 2014; 4: e1
    CrossrefPubMedSuche in Google Scholar
  • 21 Shon OJ, Lee DC, Park CH. et al. A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg 2010; 2: 76-84
    CrossrefPubMedSuche in Google Scholar
  • 22 Bergfeld JA, McAllister DR, Parker RD. et al. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med 2001; 29: 129-136
    CrossrefPubMedSuche in Google Scholar
  • 23 Lee DY, Kim DH, Kim HJ. et al. Posterior cruciate ligament reconstruction with transtibial or tibial inlay techniques: a meta-analysis of biomechanical and clinical outcomes. Am J Sports Med 2018; 46: 2789-2797
    CrossrefPubMedSuche in Google Scholar
  • 24 Oakes DA, Markolf KL, McWilliams J. et al. Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am 2002; 84: 938-944
    CrossrefPubMedSuche in Google Scholar
  • 25 Song EK, Park HW, Ahn YS. et al. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study. Am J Sports Med 2014; 42: 2964-2971
    CrossrefPubMedSuche in Google Scholar
  • 26 Lee DW, Kim JG, Yang SJ. et al. Return to sports and clinical outcomes after arthroscopic anatomic posterior cruciate ligament reconstruction with remnant preservation. Arthroscopy 2019; 35: 2658-2668.e1
    CrossrefPubMedSuche in Google Scholar
  • 27 Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 2: results of revision using a 2-strand quadriceps tendon-patellar bone autograft. Am J Sports Med 2005; 33: 655-665
    CrossrefPubMedSuche in Google Scholar
  • 28 Kim J, Allaire R, Harner CD. Vascular safety during high tibial osteotomy: a cadaveric angiographic study. Am J Sports Med 2010; 38: 810-815
    CrossrefPubMedSuche in Google Scholar
  • 29 Kennedy NI, LaPrade RF, Goldsmith MT. et al. Posterior cruciate ligament graft fixation angles, part 2: biomechanical evaluation for anatomic double-bundle reconstruction. Am J Sports Med 2014; 42: 2346-2355
    CrossrefPubMedSuche in Google Scholar
  • 30 Li Y, Li J, Wang J. et al. Comparison of single-bundle and double-bundle isolated posterior cruciate ligament reconstruction with allograft: a prospective, randomized study. Arthroscopy 2014; 30: 695-700
    CrossrefPubMedSuche in Google Scholar
  • 31 Yoon KH, Kim EJ, Kwon YB. et al. Minimum 10-year results of single- versus double-bundle posterior cruciate ligament reconstruction: clinical, radiologic, and survivorship outcomes. Am J Sports Med 2019; 47: 822-827
    CrossrefPubMedSuche in Google Scholar
  • 32 Qi YS, Wang HJ, Wang SJ. et al. A systematic review of double-bundle versus single-bundle posterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2016; 17: 45
    CrossrefPubMedSuche in Google Scholar
  • 33 Lorenz S, Elser F, Brucker PU. et al. Radiological evaluation of the anterolateral and posteromedial bundle insertion sites of the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2009; 17: 683-690
    CrossrefPubMedSuche in Google Scholar
  • 34 Rauch AC, Schottle PB, Beitzel K. et al. Die Zwei-Bündel-Technik – eine anatomische Rekonstruktion des hinteren Kreuzbandes. Oper Orthop Traumatol 2010; 22: 387-401
    CrossrefPubMedSuche in Google Scholar
  • 35 Weiler A, Jung TM, Strobel MJ. Arthroskopisch assistierter hinterer Kreuzbandersatz und posterolaterale Stabilisierung mit Semitendinosus-/Grazilissehnen. Unfallchirurg 2006; 109: 61-71
    CrossrefPubMedSuche in Google Scholar
  • 36 Hoher J, Scheffler S, Weiler A. Graft choice and graft fixation in PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2003; 11: 297-306
    CrossrefPubMedSuche in Google Scholar
  • 37 Domnick C, Kosters C, Franke F. et al. Biomechanical properties of different fixation techniques for posterior cruciate ligament avulsion fractures. Arthroscopy 2016; 32: 1065-1071
    CrossrefPubMedSuche in Google Scholar
  • 38 Behrendt P, Akoto R, Mader K. et al. Hamburger Konzept der operativen Versorgungsstrategie einer akuten Kniegelenkluxation (Schenck IV): Videobeitrag. Unfallchirurg 2021; 124: 856-861
    CrossrefPubMedSuche in Google Scholar
  • 39 Heitmann M, Akoto R, Krause M. et al. Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option-results of a multicentre study. Knee Surg Sports Traumatol Arthrosc 2019; 27: 2710-2718
    CrossrefPubMedSuche in Google Scholar
  • 40 Gensior TJ, Mester B, Achtnich A. et al. Anatomic repair and ligament bracing as an alternative treatment option for acute combined PCL injuries involving the posteromedial or posterolateral corner—results of a multicentre study. Arch Orthop Trauma Surg 2023; 143: 7123-7132
    CrossrefPubMedSuche in Google Scholar
  • 41 Choi NH, Kim SJ. Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia. Arthroscopy 1997; 13: 759-762
    CrossrefPubMedSuche in Google Scholar
  • 42 Frosch K, Proksch N, Preiss A. et al. Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach. Oper Orthop Traumatol 2012; 24: 348-353
    CrossrefPubMedSuche in Google Scholar
  • 43 Willinger L, Imhoff AB, Schmitt A. et al. Refixation tibialer knöcherner Avulsionsverletzungen des hinteren Kreuzbandes in Fadenankertechnik. Oper Orthop Traumatol 2019; 31: 3-11
    CrossrefPubMedSuche in Google Scholar
  • 44 Zhang H, Hong L, Wang XS. et al. All-arthroscopic repair of arcuate avulsion fracture with suture anchor. Arthroscopy 2011; 27: 728-734
    CrossrefPubMedSuche in Google Scholar
  • 45 Winkler PW, Wagala NN, Carrozzi S. et al. Low posterior tibial slope is associated with increased risk of PCL graft failure. Knee Surg Sports Traumatol Arthrosc 2022; 30: 3277-3286
    CrossrefPubMedSuche in Google Scholar
  • 46 Gwinner C, Jung TM, Schatka I. et al. Posterior laxity increases over time after PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27: 389-396
    CrossrefPubMedSuche in Google Scholar
  • 47 Winkler PW, Zsidai B, Wagala NN. et al. Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2021; 29: 682-693
    CrossrefPubMedSuche in Google Scholar