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Patellaluxationen

Dislocations of the patella

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Zusammenfassung

Die Patellaluxation ist ein häufiges Ereignis im Kindes- und Jugendalter und kommt als traumatische, rezidivierende, habituelle und chronische Form vor. Es gibt eine Reihe luxationsbegünstigender anatomischer Faktoren. Die Therapie der traumatischen Erstluxation ist generell konservativ. Nur bei Vorliegen osteochondraler Fragmente oder sehr schweren Weichteilverletzungen kommt eine primäre operative Behandlung in Frage. Für die rezidivierende, habituelle und chronische Luxation sind operative Therapiemaßnahmen überlegen. Es kommt die Versetzung des M. vastus medialis, die Rekonstruktion des Lig. patellofemorale mediale, die Doppelung des medialen Retinakulums in Kombination mit einem lateralen Release und Zügelungen der Patella oder Versetzungen des Ansatzes des Lig. patellae zum Einsatz. Ein anderer Ansatz ist die Verbesserung des femoropatellaren Gleitlagers durch die Trochleaplastik. Alle Langzeitergebnisse, v. a. die mit knöchernen Eingriffen am Patellarsehnenansatz oder der Trochlea, weisen gute Ergebnisse in Bezug auf die Verhinderung weiterer Luxationsereignisse aber mittelmäßige im Hinblick auf die Entstehung einer Femoropatellargelenkarthrose auf.

Abstract

Dislocation of the patella represents a frequent knee problem in childhood and adolescence. There are traumatic, recurrent, habitual and chronic forms. Many anatomical variations, which promote patellar dislocation, are known. The first traumatic dislocation is primarily treated conservatively with the exception of concomitant osteochondral fragments or very large soft tissue damage which justify surgical interventions. Recurrent, habitual and chronic dislocations are best cured surgically by vastus medialis advancement, reconstruction of the medial patellofemoral ligament, strengthening of the medial retinaculum together with a lateral release and by fixation of the patella using tendon grafts or medialisation of the insertion of the patellar ligament. To improve the femoropatellar groove by trochleaplasty is a different surgical concept. The long-term results following medialisation of the patellar ligament insertion or trochleaplasty are good with regards to patellar stability but mediocre in terms of avoiding degenerative changes in the patellofemoral joint.

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  1. Klinik für Orthopädie, Olgahospital, Klinikum Stuttgart, Bismarckstraße 8, 70176, Stuttgart, Deutschland

    T. Wirth

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Wirth, T. Patellaluxationen. Unfallchirurg 114, 388–395 (2011). https://doi.org/10.1007/s00113-011-1968-z

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