Zusammenfassung
Eine Knieluxation ist eine schwerwiegende Verletzung, bei der mindestens 2 der 4 ligamentären Hauptstabilisatoren des Kniegelenks betroffen sind. Diese Verletzung führt zu einer multidirektionalen Instabilität. Im Rahmen der Luxationen des Kniegelenks können auch die A. poplitea und der N. peroneus geschädigt werden. Bei Luxationen mit Gefäßbeteiligung handelt es sich um eine potenziell extremitätenbedrohende Verletzung. Die Diagnosestellung der Knieluxation kann aufgrund einer hohen Rate spontaner Repositionen bei der Erstuntersuchung erschwert sein. Knieluxationen sind selten und treten hauptsächlich bei jungen Männern auf. Sie werden oft durch hochenergetische Traumata verursacht, können jedoch auch durch niedrigenergetische Verletzungen bedingt sein. Adipositas erhöht das Risiko für Knieluxationen. Die Klassifikation einer Knieluxation basiert auf den beteiligten anatomischen Strukturen und der Luxationsrichtung. Die akute Behandlung umfasst Reposition und stabilisierende Maßnahmen. Begleitverletzungen wie Gefäß‑, Nerven‑, Streckapparat- und osteochondrale Verletzungen sowie Frakturen und Meniskusverletzungen beeinflussen das therapeutische Vorgehen und das Behandlungsergebnis. Die definitive operative Therapie hängt von der Schwere der Verletzung ab und kann eine ligamentäre Rekonstruktion oder Naht mit „bracing“ beinhalten. Die Nachbehandlung sollte individuell angepasst werden und zielt auf die Wiederherstellung einer stabilen und funktionsfähigen Kniegelenkfunktion ab. Komplikationen wie Arthrofibrose, N.-peroneus-Parese, Kompartmentsyndrom, postoperative Infektion und Rezidivinstabilitäten können auftreten. Langfristig besteht ein erhöhtes Risiko für die Entwicklung einer symptomatischen Arthrose.
Abstract
A knee dislocation is a serious injury involving at least two of the four major ligamentous stabilizers of the knee. This injury results in multidirectional knee instability. In dislocation of the knee the popliteal artery and the peroneal nerve can also be damaged. Dislocations with vascular involvement are potentially threatening injuries of the lower extremities. The diagnosis of knee dislocation can be difficult due to a high rate of spontaneous reduction at the initial examination. Knee dislocations are rare and mainly occur in young men. They are mostly caused by high-energy trauma; however, they can also be caused by low-energy injuries. Obesity increases the risk of knee dislocations. The classification of a knee dislocation is based on the anatomical structures involved and the direction of dislocation. The acute treatment includes reduction and stabilization measures. Associated injuries, such as vascular, nerve, extensor mechanism and cartilage injuries as well as fractures and meniscal injuries can influence the treatment approach and the outcome. The definitive surgical treatment depends on the severity of the injury and can include ligament reconstruction or repair with bracing. The aftercare should be individually adapted with the aim to restore knee joint stability and function. Complications such as arthrofibrosis, peroneal nerve palsy, compartment syndrome, postoperative infection and recurrent instability can occur. In the long term, patients have an increased risk for the development of symptomatic osteoarthritis.
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T.R. Pfeiffer bezieht Forschungsgelder von Arthrex und erhält Redner-Honorare von Arthrex, Rimasys. D. Günther bezieht Forschungsgelder von Arthrex, hält Beraterverträge von Arthrex, Stryker, Storz, Medical Magnesium, erhält Redner-Honorare von Geistlich, Codon, Medi, Anika, Telos, Rimasys und erhält Reisekostenzuschüsse von Smith & Nephew.
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Julian Mehl, München
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Pfeiffer, T.R., Günther, D. Behandlung der akuten Knieluxation. Unfallchirurgie 127, 35–43 (2024). https://doi.org/10.1007/s00113-023-01369-y
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DOI: https://doi.org/10.1007/s00113-023-01369-y