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Selected Publication:
Koeninger, V.
Retrospektive Analyse der Demographie und Versorgung von Verletzungen des vorderen Kreuzbandes in der Ski- und Tourismusregion Dachstein-Schladming im Zeitraum 2020 bis 2021
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 70
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- Authors Med Uni Graz:
- Advisor:
- Mattiassich Georg
- Seibert Franz
- Altmetrics:
- Abstract:
- Background: Anterior cruciate ligament (ACL) rupture is a common injury that often occurs during activities including pivoting or contact sports. Due to the increasing interest in sports, this injury is becoming more and more common. The rupture of the anterior cruciate ligament may be treated surgically or non-surgically. The aim in both treatment options is to restore a stable and functional knee joint. Various factors such as accompanying injuries, individual activity level should be considered in the decision of the therapy. However, it should be decided in consultation with the patient. Compliance is important for both therapeutic approaches in order to achieve a good clinical outcome. Above all, physiotherapy exercises should be regularly performed as it plays a major role in muscle growth, which contributes to stabilize the knee joint. In ACL-reconstruction, there is still no gold standard regarding which surgical method should be used. As a lesion of the anterolateral ligament (ALL) could be responsible for the remaining instability after an isolated ACL-reconstruction, combined ACL-/ALL-reconstruction has become more popular in the last few years. The ALL surgical technique is a combined reconstruction of the ACL as well as the ALL. First of all an overview of ACL-rupture will be given. The aim of this paper is to present the surgical treatment strategies with focus on combined ACL-/ALL- reconstruction. The anatomy, biomechanics, and function of the ALL as well as its role in ACL-reconstruction will be considered. Moreover, the conventional ACL- reconstruction will be compared with the combined ACL-/ALL-reconstruction based on clinical data in order show the relevance of the ALL in ACL-reconstruction. Method: On the one hand, literature on ACL-reconstruction with focus on the ALL was researched. On the other hand, clinical data of the Clinic Diakonissen Schladming from January 2020 to December 2021 were used for this paper. Conventional ACL- reconstruction was compared with additional ALL-reconstruction in terms of postoperative pain, mobility and stability after three to twelve months, and rerupture rate. Postoperative pain was assessed with the visual analogue scale (VAS), where “zero” represents "no pain" and “ten” represents "pain as bad as it could possibly be." Range of motion was measured using the neutral-zero-method. Stability was both evaluated by asking the patients at postoperative controls and by using stability tests such as the Lachman test and the pivot shift test. The rerupture rate only consulted ruptures of the reconstructed ACL. Results: The results consider the differences between the two surgical methods in terms of operative time, length of hospital stay, postoperative stability, range of motion, pain and rerupture rate. The results of combined ACL-/ALL-reconstruction represented shorter operative time, better subjective and objective stability results and a lower rerupture rate. The hospital stay which was 4,6 days in the ACL-group and 4,4 days in the ALL-group proved to be almost similar. The range of motion also proved similar in both groups with an average of 0-0,3-130,8 degrees after ACL- reconstruction and 0,8-0,5-132,9 degrees after ACL-/ALL-reconstruction. Anyway, more patients of the ALL-group were found to have an extension deficit, whereas a flexion deficit was found in more patients of the ACL-group.