Zusammenfassung
Verletzungen und Insuffizienzen der Quadrizepssehne bei liegender Knietotalendoprothese stellen eine seltene, aber schwerwiegende Verletzung dar, die unbehandelt zum weitgehenden Funktionsverlust des Kniegelenks führt. Der Übersichtsbeitrag erläutert die funktionelle Anatomie, die Risikofaktoren, die Diagnostik von Verletzungen der Quadrizepssehne sowie die möglichen Versorgungsverfahren bei Partial- und Komplettrupturen. Die Behandlungsoptionen richten sich nach dem Grad des funktionellen Verlusts (partiell, komplett) sowie dem Verletzungszeitpunkt (akut vs. chronisch). Weitergehend muss in die Wahl des Behandlungsverfahrens die Qualität und Verfügbarkeit des Primärgewebes, der allgemeine Gesundheitszustand sowie das funktionelle Anforderungspotenzial des Patienten in die Entscheidung einbezogen werden. Ein konservatives Vorgehen ist häufig bei Partialrupturen gerechtfertigt und mit guten klinischen Ergebnissen assoziiert. Die vollständige Ruptur der Quadrizepssehne erfordert die operative Intervention. Für die Versorgung von Komplettrupturen sind vielfältige operative Versorgungstechniken beschrieben. In der Erstversorgung kompletter Quadrizepssehnenrupturen nach Implantation einer Knieendoprothese ist die primäre Naht mit autologer oder synthetischer Augmentation zu präferieren. Bei chronischen Insuffizienzen sowie desolater Weichteilsituation stellen die Versorgungen mithilfe gestielter Muskellappen oder tendoossärer Allografts Behandlungsalternativen dar. Alle bisher zur Verfügung stehenden operativen Interventionsmöglichkeiten sind komplikationsbehaftet und führen nicht selten zu einem unbefriedigenden Ergebnis. Ein neuer operativer Ansatz zur Rekonstruktion und Augmentation des Streckapparats ist die Verwendung eines synthetischen Netzes, deren Technik im Detail beschrieben wird.
Abstract
Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient’s general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.
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K. Thiele, P. von Roth, T. Pfitzner, B. Preininger und C. Perka geben an, dass kein Interessenkonflikt besteht.
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Thiele, K., von Roth, P., Pfitzner, T. et al. Quadrizepssehneninsuffizienzen und -rupturen. Orthopäde 45, 407–415 (2016). https://doi.org/10.1007/s00132-016-3258-5
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DOI: https://doi.org/10.1007/s00132-016-3258-5
Schlüsselwörter
- Allografts
- Prothesenversagen
- Wiederherstellende chirurgische Eingriffe
- Sehnenverletzungen
- Risikofaktoren