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Research Day
AGA2012-54
Computer Navigierte Rekonstruktion des vorderen Kreuzbandes: Gibt es
geschlechtsspezifische Unterschiede im Outcome zwischen der Single- und Double Bundle
Technik ?
Gender Differences after Computer Navigated Single- and Double-Bundle Anterior Cruciate
Ligament Reconstruction - Clinical Follow Up At a Minimum of 2 Years
Authors
* Marcus Hofbauer Universitätsklinik für Unfallchirurgie , Medizinische Universität Wien, Wien, Austria
Markus Winnisch Universitätsklinik für Unfallchirurgie , Medizinische Universität Wien, Wien, Austria
Roman Ostermann Universitätsklinik für Unfallchirurgie , Medizinische Universität Wien, Wien, Austria
Silke Aldrian Universitätsklinik für Unfallchirurgie , Medizinische Universität Wien, Wien, Austria
Abstract
Fragstellung: Women not only demonstrate an increased risk for injury, but also a poorer response following
anterior cruciate ligament (ACL) rupture. However, no study has investigated possible gender differences between
computer-navigated single-bundle and double-bundle technique. The aim of this study was to evaluate the effects
of gender on the outcome of computer navigated single- and double-bundle ACL reconstruction and to present
reference values.
Methodik: A retrospective review was conducted of 55 consecutive patients after single-bundle or double-bundle
ACL reconstruction procedure with the use of autogenous hamstring tendon grafts and the EndoButton®-fixation
with a minimum follow-up of 24 months. There were 18 males and 10 females in the double-bundle group and 15
males and 12 females in the single-bundle group. Intraoperatively, the anteroposterior and rotational laxity were
measured and collected with the computer navigation system. Objective analysis of results included pivot-shift
testing and KT-1000 arthrometer testing for side-to-side differences at follow-up examination. Subjective analysis
consisted of International Knee Documentation Committee (IKDC) form, the Lysholm score and Tegner score.
The radiographic outcome was assessed post-operatively and during follow-up using standard anterior-posterior
and lateral views of the knee joint.
Ergebnis: Preoperatively, both groups showed a significant higher internal rotation in female patients (singlebundle
group, mean difference: 2,5°, p < 0,001; double-bundle group, mean difference; 2,1°, p < 0,001).
Regarding the postoperative reduction in internal rotation, females of the sindle-bundle groups revealed a greater
reduction compared to males (mean difference 2,3°, p < 0,001) whereas females of the double-bundle group
revealed a significantly greater post-operative reduction in anterior-posterior translation (mean difference 1,6mm,
p = 0,04). Gender had no significant impact on KT-1000 values and the pivot-shift test 2 years postoperatively.
Female patients after double-bundle procedure reported a significant worse IKDC score (88,6 vs. 97,2 points; p =
0,002), Lysholm score (92,1 vs. 98,7 points; p < 0,001) and Tegner score (5,6 vs. 8,1 points; p < 0,001) compared
to male patients. All score values of the female double-bundle group were worse than in the female single-bundle
group. In contrast, male patients showed better results of IKDC score, Lysholm score and Tegner score after
double-bundle procedure compared to single-bundle technique.
Schlussfolgerung: Our findings in the case of double-bundle hamstring grafts point to a decreased laxity but
also to decreased IKDC-, Lysholm- and Tegner score values of the operated limb in females 2 years
postoperatively. The gender-based relationship between joint function and outcome after ACL reconstruction
remains unclear and requires further investigation.
Keywords
Gender differences, Computer navigation, Anterior cruciate ligament (ACL), hamstrings, single bundle, double
16.03.2012 29
Vortrag
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