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Patella-Sleeve-Fraktur

Bracing- und Augmentationstechnik mit einem Fadentape

Patellar sleeve fractures

Bracing and augmentation technique with suture tape

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Transossäre, metallfreie Augmentation der Patellarsehne am distalen Patellapol mit dem Ziel der Wiederherstellung der Streckfunktion des Kniegelenks.

Indikationen

Akute Verletzung des Streckapparats des Kniegelenks mit Abriss des proximalen bzw. distalen Patellapols und einhergehendem Kraftverlust.

Kontraindikationen

Infektionen des Kniegelenks, schwere Weichteilschäden (relative Kontraindikation), Patellafrakturen oder Frakturen der Tuberositas tibiae.

Operationstechnik

Zentraler Zugang zur Patella. Scharfes Spalten der Faszie und des Periosts in ihrem Verlauf. Darstellen des Patellarsehnenansatzes. Débridieren des abgelösten Periosts und möglicher osteochondraler Fragmente. Transossäres Einziehen von 2 Fadentapes (FiberTape®, Fa. Arthrex, Naples, Fl, USA) zur Augmentation der Patellarsehne am betroffenen Patellapol und nachfolgender Adaptation des Periosts an die Patella in Shoestring-Technik.

Weiterbehandlung

Für 2 Wochen Teilbelastung in Streckorthese. Danach Belastungsaufbau in Streckstellung. Passive Bewegungsübungen für 2 Wochen bis 30°-Flexion. Steigerung nach 2 und 4 Wochen jeweils um 30°-Flexion. Isometrieübungen ab 3. Woche postoperativ. Bewegungsfreigabe und Extensionsübungen gegen Widerstand ab 7. Woche postoperativ.

Ergebnisse

Bei rechtzeitiger und korrekter Diagnose und suffizienter Refixation des Periosts an den Knochenkern der Patella werden meist sehr gute funktionelle Ergebnisse erreicht.

Abstract

Objective

Transosseous augmentation of patellar sleeve fractures (PSF) with suture tape in young athletes.

Indications

Acute avulsions of the proximal or distal patellar pol with clinical relevant deficit of knee extension.

Contraindications

Local infections, severe soft tissue damage (relative contraindication), fractures of the patella or tibial tuberosity.

Surgical technique

Direct longitudinal anterior approach to the patella. Debridement of the proximal patellar tendon insertion. Anatomic reduction of any osteochondral fragments. Transosseous augmentation of the tendon with FiberTapes® (Arthrex, Naples, FL, USA).

Postoperative management

Passive motion exercise to 30° of flexion from day 1; increase to 60° from week 3; 90° from week 5. Partial load-bearing of 20 kg with knee in locked full extension brace during first 2 weeks. Isometric exercises from week 3. Free active ROM and full weight bearing from week 7.

Results

If diagnosis and treatment is early and sufficient augmentation of the tendon and periosteum is provided, good to excellent functional outcome can be expected.

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Literatur

  1. Ray JM, Hendrix J (1992) Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 32(4):464–467

    Article  CAS  Google Scholar 

  2. Duri ZA, Patel DV, Aichroth PM (2002) The immature athlete. Clin Sports Med 21(3):461–482

    Article  Google Scholar 

  3. Seybold D et al (2005) Avulsion fractures of the lower pole of the patella. Unfallchirurg 108(7):591–596

    Article  CAS  Google Scholar 

  4. Grogan DP et al (1990) Avulsion fractures of the patella. J Pediatr Orthop 10(6):721–730

    Article  CAS  Google Scholar 

  5. Kaivers P, Busch T, Lies A (2003) An avulsion (sleeve) fracture of the proximal patella pole in a child. Diagnosis, treatment and results in a patient after a fall onto the knee. Unfallchirurg 106(8):676–679

    Article  CAS  Google Scholar 

  6. Janko M et al (2015) Sporttraumatologische Besonderheiten am Knie im Kindesalter. OUP Orthop Unfallchir Prax 6:286–292

    Google Scholar 

  7. Damrow DS, Van Valin SE (2017) Patellar sleeve fracture with ossification of the patellar tendon. Orthopedics 40(2):e357–e359

    Article  Google Scholar 

  8. Hunt DM, Somashekar N (2005) A review of sleeve fractures of the patella in children. Knee 12(1):3–7

    Article  Google Scholar 

  9. Guy SP et al (2011) Bilateral sleeve fracture of the inferior poles of the patella in a healthy child: case report and review of the literature. Adv Orthop. https://doi.org/10.4061/2011/428614

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bruijn JD, Sanders RJ, Jansen BR (1993) Ossification in the patellar tendon and patella alta following sports injuries in children. Complications of sleeve fractures after conservative treatment. Arch Orthop Trauma Surg 112(3):157–158

    Article  CAS  Google Scholar 

  11. Nath PI, Lattin GE Jr. (2010) Patellar sleeve fracture. Pediatr Radiol 40(Suppl 1):S53

    Article  Google Scholar 

  12. Rushbrook J, Tudor F, Myers P (2015) (i) Knee injuries in children. Orthop Trauma 29(1):1–5

    Article  Google Scholar 

  13. Gupta RR et al (2006) Patellar sleeve fractures in children: a case report and review of the literature. Am J Orthop (Belle Mead, NJ) 35(7):336–338

    Google Scholar 

  14. Houghton GR, Ackroyd CE (1979) Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 61–B(2):165–168

    Article  Google Scholar 

  15. Gao GX, Mahadev A, Lee EH (2008) Sleeve fracture of the patella in children. J Orthop Surg (Hong Kong) 16(1):43–46

    Article  CAS  Google Scholar 

  16. Tsubosaka M et al (2016) A case report of sleeve fracture of the patella in a shield. J Orthop Case Reports 6(5):24–27

    PubMed  Google Scholar 

  17. Scapinelli R (1967) Blood supply of the human patella. Its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 49(3):563–570

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Tech. Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland

    V. Schütte

  2. Hospital Padre Hurtado, Santiago, Chile

    A. Schmidt-Hebbel

  3. Abteilung für Sportorthopädie, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland

    A. B. Imhoff & A. Achtnich

Authors
  1. V. Schütte
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  2. A. Schmidt-Hebbel
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  3. A. B. Imhoff
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  4. A. Achtnich
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Corresponding author

Correspondence to V. Schütte.

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Interessenkonflikt

V. Schütte, A. Schmidt-Hebbel, A.B. Imhoff und A. Achtnich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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W. Petersen, Berlin

Zeichner

R. Himmelhan, Mannheim

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Schütte, V., Schmidt-Hebbel, A., Imhoff, A.B. et al. Patella-Sleeve-Fraktur. Oper Orthop Traumatol 31, 56–62 (2019). https://doi.org/10.1007/s00064-018-0581-5

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  • DOI: https://doi.org/10.1007/s00064-018-0581-5

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