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Diagnostisches Vorgehen beim Kniegelenktrauma im Kindes- und Jugendalter

Gestern und heute

Diagnostic approaches to acute knee injury in childhood and adolescence

Yesterday and today

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Zusammenfassung

Einleitung

Knieverletzungen im Kindesalter sind häufig der klinischen Untersuchung schwer zugänglich und werden heute oft durch eine MRT-Bildgebung ergänzt. Ziel der vorliegenden Studie war es, einerseits die Indikation zur diagnostischen Arthroskopie beim Kniegelenktrauma kritisch zu überprüfen und andererseits die Indikation für eine MRT-Untersuchung differenziert zu betrachten.

Methodik

In den Jahren 1990–1999 wurden 87 Kinder ohne MRT aufgrund des klinischen Befundes arthroskopiert (Gruppe 1). In den Jahren 2000–2006 wurden 83 Patienten zunächst durch die MRT diagnostisch abgeklärt und nachfolgend arthroskopiert (Gruppe 2).

Ergebnisse

Die klinische Verdachtsdiagnose wurde in Gruppe 1 bei 79% der Patienten durch die Arthroskopie bestätigt. In Gruppe 2 stimmten die klinische und die arthroskopische Diagnose bei 60% der Patienten überein. Der MRT-Befund wurde in Gruppe 2 bei allen Patellaluxationen, bei 83% der ligamentären Verletzungen und bei 56% der Meniskusverletzungen arthroskopisch bestätigt. Letztlich konnte durch den Einsatz der MRT der Anteil der rein diagnostischen Arthroskopien von 22% auf 13% reduziert werden.

Schlussfolgerungen

Die Anzahl rein diagnostischer Arthroskopien im Kindesalter kann durch den Einsatz der MRT gesenkt werden.

Abstract

Introduction

Clinical examination of acute knee injury in childhood is often difficult and therefore magnetic resonance imaging (MRI) serves as an additional diagnostic tool. The aim of the present study was to evaluate on the one hand the indications for diagnostic arthroscopy and on the other hand the indications for MRI.

Methods

Of the children treated between 1990 and 1999, 87 (group 1) underwent arthroscopy after clinical examination. Between 2000 and 2006 (group 2) 83 patients were examined using MRI after clinical examination and 53 were subsequently submitted to arthroscopy.

Results

In group 1 the clinical diagnosis was verified by arthroscopy in 79%. In group 2 the clinical and arthroscopic diagnoses were consistent in 60% of the patients. The MRI diagnosis was correctly recognized for patella dislocation in all cases, for ligament injuries in 83% and for meniscus injuries in 56%. Due to the application of MRI before arthroscopy the fraction of diagnostic arthroscopies could be reduced from 22% to 13%.

Conclusion

The number of diagnostic arthroscopies in childhood can be reduced by application of MRI.

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Danksagung

Teile der Ergebnisse wurden unter Einbeziehung der Dissertation von Tanja Förster erstellt.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Deutschland

    M. Maier, E.V. Geiger, L. Sellnow, D. Schneidmüller, N. Vennemann & I. Marzi

  2. Institut für Diagnostische und Interventionelle Radiologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Frankfurt am Main, Deutschland

    M. Mack

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  1. M. Maier
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  2. E.V. Geiger
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  3. L. Sellnow
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  4. D. Schneidmüller
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  5. N. Vennemann
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  6. M. Mack
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  7. I. Marzi
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Correspondence to M. Maier.

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Maier, M., Geiger, E., Sellnow, L. et al. Diagnostisches Vorgehen beim Kniegelenktrauma im Kindes- und Jugendalter. Unfallchirurg 114, 141–148 (2011). https://doi.org/10.1007/s00113-009-1713-z

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  • DOI: https://doi.org/10.1007/s00113-009-1713-z

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