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Avulsionsverletzungen

„Root tears“

Avulsion injuries

Root tears

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Eine Avulsion des Meniskushinterhorns im Bereich der tibialen Insertion („root tear“) ist eine häufig übersehene Läsion. Biomechanische Studien konnten zeigen, dass eine Avulsion zum Verlust der Meniskusfunktion führt und der Effekt somit einer Meniskektomie gleicht. Diese Grundlagenforschung wird durch klinische Studien mit progredienter Arthrose nach Avulsion unterstützt.

Eine Avulsion des Meniskushinterhorns kann durch eine kombinierte Flexions-/Rotationsbewegung isoliert oder in Kombination mit einer Läsion des vorderen Kreuzbandes (VKB) auftreten. Auch bei posteriorer Platzierung des tibialen Tunnels im Rahmen einer VKB-Rekonstruktion kann es zu dieser Läsion kommen. Die Diagnose ist durch die unspezifische Klinik erschwert. Mit koronaren Schichten in der MRT-Diagnostik ist eine Extrusion feststellbar. Arthroskopisch kann die Funktion der Insertion mit Hilfe des Tasthakens überprüft werden, was bei intakter VKB-Struktur technisch allerdings anspruchsvoll ist. Eine Refixation der abgelösten Meniskusinsertion kann mit einer Ankertechnik oder über einen tibialen Tunnel durchgeführt werden.

Abstract

An avulsion of the insertion of the meniscus is defined as a root tear. In the clinical practice the incidence of this lesion is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a meniscectomy. Clinical studies documented progredient arthritic changes thereby supporting the basic science studies.

The injury mechanism of a root tear can be a valgus/rotational trauma of the knee joint resulting in an isolated avulsion or associated lesion of the anterior cruciate ligament (ACL) rupture. Another mechanism is a posterior tibial tunnel placement during ACL reconstruction. The diagnostic approach is limited by unspecific clinical symptoms and MRI can be helpful for evaluating meniscal extrusion as a sign of a root tear. During arthroscopy the function of the root can be assessed using a probe. However, visualization of the medial and lateral meniscus insertion is challenging. A refixation of the root can be performed using an anchor or tibial tunnel approach and a two suture technique.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: beratende Tätigkeit bei Fa. Karl Storz.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyer-Str. 1, 48149, Münster, Deutschland

    T. Zantop

  2. Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus, Berlin-Grunewald, Berlin, Deutschland

    W. Petersen

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Correspondence to T. Zantop.

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Zantop, T., Petersen, W. Avulsionsverletzungen. Arthroskopie 24, 48–56 (2011). https://doi.org/10.1007/s00142-010-0595-y

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  • DOI: https://doi.org/10.1007/s00142-010-0595-y

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