Der Unfallchirurg
-
Operative repair in ruptures of the extensor mechanism of the knee joint mostly requires additional external or internal fixation by plaster, transfer of tendons or encircling wires. Reconstruction of initially undiagnosed ruptures has to solve the problems of fixed proximal or distal migration of the patella and tendenous shortening. ⋯ During this period as well as a post-operative protection this fixator enables patients to maintain motion of the knee joint and full weightbearing. This technique can avoid poor functional results caused by long periods of immobilisation and is helpful in patients with marked displacement of the patella and inability to manually reduce the patella distally when delayed repair is necessitated.
-
Comparative Study
[Considerations for the indications for anterior cruciate ligament reconstruction. Results of conservative versus operative treatment].
Medium-term results with a follow-up of at least 3 years were done in 160 patients (average follow up 51 months) after ACL reconstruction using IKDC evaluation form and Noyes score and in 110 patients (average follow Up 53 months) after non-operative management. Unlike objective good parameters the subjective assessment of knee function according to the Noyes score reveals significantly worse results in cases with ACL reconstruction compared to the knees without surgery. The best functional results we found in professional athletes after ACL reconstruction. ⋯ Only when menisceal lesions appear or patients suffer from giving way episodes we support secondary surgery. The pivot shift sign is reflecting the dynamic aspect of knee instability. In our opinion it is the decisive parameter to assess knee instability unless there are useful technical procedures.