[Management of long-standing instabilities of the knee ligaments]

Since 1975, a total of 1015 knee ligament grafts have been carried out in the orthopedic department of the St. Elisabeth-Klinik in Saarlouis. Proceeding from the method of extra-articular stabilization that was taken over and modified by Mittelmeier, the authors initially favored Ellison's method of lateral ligament displacement, supplementing the operation by diverting the nerve tract. Although the results of surgery were not bad, the importance of rotational instability led the authors increasingly to turn to intra-articular stabilization. Today, the most commonly used methods for frontal instability are those modified by Brückner or Glency, both with good results. With regard to ligament prostheses, the authors tend to be more cautious. Certainly, the alloplastic artificial ligament replacement is an important advance in the case of certain indications, but is probably only a further element of future developments. Many of the problems encountered by Fritz Lange with his first, silk plastic ligament replacement, described by Max Lange in the 1960s, are still applicable today. Here one could mention in particular the surgeon's misgivings concerning indication and the cautious estimates of the changes of success of plastic surgery of the ligaments.