Windshield wiper effect

As wiper effect ( engl. Windshield wiper effect ) is known in the orthopedic and trauma surgery a phenomenon that after the reconstruction of a torn cruciate ligament ( ACL rupture ) to instability of the knee joint may result. The windshield wiper effect widening the drill channel in which the cruciate ligament graft is located. It is closely related to the bungee effect .

description

Schematic representation of the movement of the graft with the windshield wiper effect.

Relative movements between the transplant and the drill channel in which the transplant is located can lead to the expansion of the drill channel. With the windshield wiper effect, there is a waving transverse movement of the graft when the knee is moved. This effect occurs mainly when using patellar tendon transplants in the BTB technique (BTB = bone-tendon-bone ) in the single incision design . In this version, the tibial bone block (the one that is fixed to the shinbone) lies about 20 mm deep in the tibial drill channel and there has a relatively large amount of clearance in the drill channel. This enables transversal movements of the graft, which lead to a widening of the drill channel. The windshield wiper effect leads to tunnel widening, especially in the tibia, and thus to increased residual instability in the knee. In extreme cases, graft failure can result. The windshield wiper effect can be made visible radiologically . For example, the widening of the drill channel can be clearly seen in the X-ray image .

The similarity of the direction of movement of the graft with that of a windshield wiper gave the windshield wiper effect its name. The effect was first described in 1997 by JC L'Insalata and colleagues.

Avoidance of the windshield wiper effect

Fixing the grafts close to the joints is a measure to prevent the windshield wiper effect.

Individual evidence

1. ↑ A. Neddermann: The phenomenon of the bore channel enlargement after replacement of the anterior cruciate ligament in growing sheep: An interdisciplinary study in the sheep model. Dissertation, University of Hanover, 2008
2. ↑ W. Attmanspacher et al.: Replacement of the anterior cruciate ligament in the TransFix® technique. In: Arthoskopie 12, 1999, pp. 305-312. doi : 10.1007 / s001420050107
3. ↑ R. Klatt: Long-term results after reconstruction of the anterior cruciate ligament using a carbon fiber implant. Dissertation, Heinrich Heine University Düsseldorf, 2004
4. ^ JC L'Insalata et al .: Tunnel expansion following anterior cruciate ligament reconstruction. In: Knee Surgery, Sports Traumatology, Arthroscopy 5, 1997, pp. 234-238. PMID 9430573
5. ^ W. Petersen and T. Zantop: The anterior cruciate ligament: Basics and current practice of operative therapy. Deutscher Ärzteverlag, 2009, ISBN 3-769-10562-1 , pp. 202f. limited preview in Google Book search

further reading

• J. Lützner and M. Bottesi: Reconstruction of the anterior cruciate ligament. In: Trauma und Berufskrankheit 11, 2009, pp. 136–139. doi : 10.1007 / s10039-008-1469-7
• M. Schuh: The outpatient arthroscopically-assisted reconstruction of the anterior cruciate ligament with a free patellar tendon transplant. Dissertation, Friedrich Schiller University Jena, 2005
• HH Paessler and DS Mastrokalos: Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. In: Orthop Clin North Am 34, 2003, pp 49-64. PMID 12735201 (Review)

Web links

• Reconstruction of the anterior cruciate ligament