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Evidenzbasierte Indikationsstellung bei Patellaluxation

Evidence-based treatment protocol to manage patellar dislocation

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Zusammenfassung

Patellaluxationen treten üblicherweise nach lateral auf und führen in >90% der Fälle zu einer Ruptur des medialen patellofemoralen Ligaments. Verlässliche Daten und Prognosefaktoren für die Stabilität des Patellofemoralgelenks und die Patientenzufriedenheit nach entweder konservativer oder operativer Behandlung sind umstritten. Für rezidivierende Patellaluxationen fehlen randomisierte Studien bislang vollständig. In Zusammenschau der bisherigen randomisierten Studien zur Patellaerstluxation lässt sich kein signifikanter Unterschied zwischen operativer und konservativer Versorgung zeigen. Dies gilt gleichermaßen für Kinder und Jugendliche wie Erwachsene. Es besteht eine deutliche Tendenz zugunsten eines abwartenden Verhaltens und einer zunächst konservativen Therapie bei traumatischer Patellaerstluxation. Eine operative Versorgung ist primär lediglich bei relevanten Begleitverletzungen wie osteochondralen Frakturen und sekundär bei rezidivierenden Luxationen indiziert. Weitere prospektiv-randomisierte Studien mit standardisierten operativen wie konservativen Therapiemaßnahmen und ausreichend großen Fallzahlen sind erforderlich.

Abstract

Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Reliable data and prognostic factors for stability of the patellofemoral joint and satisfaction of the patient after either conservative or operative treatment have not been established yet. Until now, there are no randomized controlled trials for recurrent patellar dislocation at all. As a synopsis of the randomized controlled trials about first-time patellar dislocation, no significant difference between operative and conservative management is evident. This applies to both children and adolescents as well as to adults. There is a clear tendency towards first-line conservative therapy after traumatic patellar dislocation. Operative treatment is only required in case of accompanying injuries like osteochondral fractures or in case of recurrent dislocations. Further prospective randomized controlled trials with standardized operative and conservative treatment and patient cohorts of sufficient size are necessary in the future.

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    M. Petri, C. Krettek & M. Jagodzinski

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  1. M. Petri
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  2. C. Krettek
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  3. M. Jagodzinski
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Correspondence to M. Petri.

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Petri, M., Krettek, C. & Jagodzinski, M. Evidenzbasierte Indikationsstellung bei Patellaluxation. Unfallchirurg 115, 387–391 (2012). https://doi.org/10.1007/s00113-012-2195-y

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