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Akute mediale Seitenbandverletzung am Kniegelenk

Diagnostik und Therapie

Acute medial collateral ligament injuries of the knee

Diagnostics and therapy

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Zusammenfassung

Die Verletzung des medialen Kollateralbandes („medial collateral ligament“, MCL) ist eine der häufigsten ligamentären Verletzungen des Kniegelenks. Anamnese, klinische Untersuchung und die Magnetresonanztomographie (MRT) gehören zum diagnostischen Algorithmus. Zu unterscheiden sind komplette Rupturen von Teilrupturen. Die exakte Klassifizierung der Verletzung sowie das Ausmaß der Begleitverletzungen sind für die Behandlung von Bedeutung. Teilrupturen (Grad-I- und -II-Läsionen) werden mittels konservativer Therapie behandelt und führen meist zu guten klinischen Ergebnissen. Kontrovers diskutiert wird die Therapie bei kompletten Innenbandverletzungen (Grad-III-Läsionen). Vollständige intraligamentäre Rupturen mit guter Annäherung der Bandstümpfe und Reststabilität (bei intakter dorsaler Kapsel) können ebenfalls erfolgreich konservativ therapiert werden. Ansatznahe Rupturen und Avulsionsverletzungen haben eine schlechtere Heilungstendenz, so dass neuere Arbeiten zur operativen Therapie raten. Die Dislokation oder Dehiszenz der Bandstümpfe in der MRT spricht ebenfalls für eine operative Versorgung. Auch bei Kombinationsverletzungen mit komplexen Instabilitäten wird von vielen Autoren die operative Stabilisierung empfohlen. Bei regelhafter Primärbehandlung kommt es nur selten zu chronischen Instabilitäten. Da chronische mediale Instabilitäten am Kniegelenk therapeutisch herausfordernd sein können, kommt der richtigen und adäquaten Akutbehandlung eine hohe Bedeutung zu.

Abstract

The medial collateral ligament complex (MCL) is the most commonly damaged ligamentous stabilizer of the human knee. The diagnostic algorithm comprises patient history, clinical examination and magnetic resonance imaging (MRI). It is important to distinguish between incomplete and complete ruptures of the MCL. For adequate treatment the classification and exact knowledge about concomitant injuries are important. A nonoperative treatment of incomplete ruptures (grades I and II) is widely accepted and usually results in a good clinical outcome but the treatment of complete ruptures (grade III) is a subject of controversy. Complete intraligamentous ruptures with a correct approximation of the stumps and intact dorsomedial joint capsule can also be treated nonoperatively with good and excellent results. In contrast, ruptures close to the abutment and bony avulsions tend to heal better through operative treatment. Dehiscence or dislocation of the ligament stumps in MRI is an indication for operative treatment. In the context of a multiligamentous injury or complex instability, the majority of authors suggest an operative stabilization. As the treatment of chronic instability can be challenging, the initial and adequate treatment of acute ruptures is of great importance.

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  1. Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Hamburg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland

    M. Heitmann, A. Preiss, A. Giannakos &  K.-H. Frosch

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  1. M. Heitmann
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  2. A. Preiss
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  3. A. Giannakos
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  4. K.-H. Frosch
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Correspondence to K.-H. Frosch.

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Heitmann, M., Preiss, A., Giannakos, A. et al. Akute mediale Seitenbandverletzung am Kniegelenk. Unfallchirurg 116, 497–503 (2013). https://doi.org/10.1007/s00113-013-2371-8

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