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Anatomie und Pathologie der Bänder im oberen und unteren Sprunggelenk

Anatomy and pathology of the ligaments in the upper and lower ankle joints

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Die Distorsion des Sprunggelenks ist eine der häufigsten Verletzungen mit oft chronischen Beschwerden, Instabilität und dem Risiko einer posttraumatischen Arthrose als Folge. Beim klassischen Distorsionstrauma mit Inversion, Plantarflexion und Supination ist das Ligamentum (Lig.) tibiofibulare anterius das am häufigsten verletzte Band, gefolgt vom Lig. fibulocalcaneare. Das Lig. fibulare posterius ist nur selten betroffen. Verletzungen der Syndesmose bei forcierter Außenration des Talus gegenüber dem Unterschenkel führen primär zu einer Ruptur des vorderen Anteils. Bei der Diagnostik mittels Magnetresonanztomographie (MRT) ist insbesondere auch auf das Lig. interosseum zu achten, welches ein wichtiger Stabilisator der Malleolengabel ist. Die Anatomie und Biomechanik des medialen Bandapparats ist komplex und bildet eine funktionelle Einheit mit dem Tibiospring-Ligament-Komplex. Dieser ist ein wichtiger Stabilisator des unteren Sprunggelenks; Verletzungen zusammen mit Außenbandrupturen sind häufig. Die Bänder des Subtalargelenks sind bei Außenbandverletzungen häufig mitbetroffen und können im Rahmen einer chronischen Insuffizienz Ursache eines Pes planovalgus sein. Verletzungen von Bandstrukturen am Sprunggelenk können v. a. bei nicht suffizienter Immobilisierung während der Heilungsphase zu narbigen Veränderungen mit Bandverdickung führen. Dadurch, aber auch durch die begleitende Synovialitis kann es zum Weichteilimpingement kommen.

Abstract

Distortion of the ankle joint is one of the most common injuries and can often cause chronic pain and instability with the risk of posttraumatic osteoarthritis. The typical ankle sprain is due to inversion, plantar flexion and supination and is most commonly associated with injury of the anterior tibiofibular ligament, followed by the calcaneofibular ligament. The posterior tibiofibular ligament is rarely involved. Injuries of the syndesmosis with external rotation of the talus in the tibiotalar joint primarily lead to rupture of the anterior part of the syndesmosis. When diagnosing injuries of the syndesmosis with magnetic resonance imaging (MRI), evaluation the interosseous ligament is crucial. This ligament has an important stabilizing function of the tibiotalar joint. The anatomy and biomechanics of the medial collateral ligament are complex and have to be seen as a functional unit with the tibiospring ligament complex. The latter is frequently injured when the lateral ligaments are involved. The tibiospring ligament complex is also an important stabilizer of the subtalar joint. The ligaments of the tarsal sinus are often affected in conjunction with injuries of the lateral ligaments and may cause chronic insufficiency and a pes planovalgus deformity. Ligamentous injuries, especially when not treated with efficient immobilization during the healing phase, can cause scar tissue with thickened ligaments and synovitis. Soft tissue impingement causing chronic pain is a potential sequela.

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  1. DIE RADIOLOGIE, Sonnenstr. 17, 80331, München, Deutschland

    A. Seifarth

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Seifarth, A. Anatomie und Pathologie der Bänder im oberen und unteren Sprunggelenk. Arthroskopie 32, 125–132 (2019). https://doi.org/10.1007/s00142-018-0233-7

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