Thesis

66 Part I Chapter 3 ligament reconstruction, meniscus surgery and cartilage repair procedures [2]. Often a combination of the aforementioned procedures is used [2]. Knee arthroplasty includes partial replacement such as unicondylar knee arthroplasty (UKA) or patellofemoral joint arthroplasty (PJA), or total knee arthroplasty (TKA) [3]. In terms of TKA primary and revision total knee prosthesis should be distinguished [1]. Ligament reconstruction Repair or reconstruction of the anterior cruciate ligament (ACL) is one of the most frequently performed surgeries in orthopedics. Estimates of ACL reconstruction vary widely, but the population-adjusted estimated rate of ACL reconstructions within the US increased by 37% from 86,837 in 1994 to 134,421 in 2006 [4]. Torn ACLs might be repaired using suture devices or more often reconstructed using auto- or allografts. Repair of the ACL has been reintroduced in the last decade using sutures and novel fixation and stabilization devices [5]. ACL reconstruction partly or entirely removes the torn ACL, drills bone tunnels, introduces a variety of different auto- or allografts such as bone-patellar tendon-bone (BPTB) ACL reconstruction. It aims to replace the torn ACL by a transplant [6]. Chronic knee pain and instability after ACL reconstruction are reported in 15 to 20% of patients. Most frequent causes are graft impingement, tunnel widening, malposition of bone tunnels and graft or fixation failure [7]. With the use of biodegradable fixation devices degradation problems were seen [8]. Reconstruction of the posterior cruciate ligament (PCL) is less frequently necessary, as isolated PCL tears often heal with non-operative treatment. However, if multiple ligaments are torn – as in a knee dislocation – PCL reconstruction as well as reconstruction of all other involved ligaments is indicated [9]. These ligaments include the medial collateral, lateral collateral ligament and the posterolateral and posteromedial corner structures. Chronic knee pain and instability are not uncommon and are due to graft impingement, tunnel widening, malposition of bone tunnels and graft or fixation failure [9]. Reconstruction or repair of peripheral knee ligaments are prone to the same technical considerations, problems and complications as ACL or PCL surgery. In cases with persistent patellofemoral instability reconstruction of the medial patellofemoral ligament (MPFL) is often indicated [10]. Reefing of themedial retinaculum has not stood the test of time. Reconstruction of theMPFL can be done using gracilis or quadriceps tendon autograft or allograft. Themost commonly used graft is the gracilis tendon. The graft is used as a free graft and fixed at the patella and femur using different types of fixation devices. When using the quadriceps tendon, the graft remains attached to the patella, is redirected and then fixed at the femoral insertion using an interference

RkJQdWJsaXNoZXIy MjY0ODMw