Deutscher fusskongress regensburg 2002 - 19. Jahrestagung der ...

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Die Last-Elongationskurven der Gleitzone sowie des proximalen Sehnensegmentes unterschieden sich signifikant.
Im Bereich des medialen Malleolus war die maximale Reißkraft der Sehne signifikant niedriger als
im proximalen Anteil der Sehne.
Schlussfolgerungen: Sehnen, die um ein knöchernes Hypomochlion ziehen, bestehen in dieser Zone aus
Faserknorpel. Die Faserknorpelbildung ist als funktionelle Anpassung auf Druck und Zugbeanspruchung
anzusehen. Das Vorkommen von Faserknorpel im retromalleolären Segment der Tibialis posterior Sehne ist
als Grund für die unterschiedlichen biomechanischen Eigenschaften von retromalleolärem und proximalem
Sehnensegment anzusehen. Die verminderte Reißfestigkeit der retromalleolären Region erklärt das häufige
Auftreten spontaner Sehnenrupturen in diesem Bereich.
Titel: Total ankle arthroplasty in rheumatoid arthritis
Referenten: Bonnin, M.; Bouysset, M.; Tebib, J.; Noel, E.
Institut: Clinique Sainte Anne Lumière, Lyon
Purpose of the study: To evaluate the results and the technical difficulties of Total Ankle Arthroplasty (TAA) in
Rheumatoïd Arthritis (RA).
Material and method: From 1993 to 1999, 32 TAA were performed for RA (26 females, 16 right ankles) and
the mean age at surgery was 55 y (32 to 81). The mean duration of evolution of the RA was 17y ( 2 to 35).
18 were treated by corticosteroid and 17 by Methotrexate.
The TAA was non cemented with a mobile component: 7 Buechel-Pappas, 5 S.T.A.R. and 20 Salto. Post op,
a below knee walking cast was used during 45 days. In 21 cases, a triple arthrodesis (TA) was associated
because of a subtalar or midtarsal arthritis (SA) or a ruptured Tibialis Posterior Tendon ( TPT). F.U. was based
on visits and XR at 3, 6 and 12 months post-op and then each year. None were lost and the mean FU was 45
months (14 to 88). The functional results were analysed with the AOFAS score.
Results: We had two failure needing revision: One loosening of the talar component with migration after 4
years required an arthrodesis. One oversized talar component was revised after 1 year with a good result
(AOFAS score=92). On the 30 remaining cases, the mean AOFAS global and pain scores were respectively 82
(73 to 92) and 35 (20 to 40).
The complications were: 2 skin necrosis, one treated with local treatment and one with plastic surgery. 3 subsidence
of components, 1 on the tibia and 3 on the talus. 1 malposition of the talar component (anterior translation)
was asymptomatic. 2 fractures of the medial malleolus during surgery healed with no consequences.
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