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Achillessehnen- und Tibialis-anterior-Sehnenruptur

Achilles tendon ruptures and tibialis anterior tendon ruptures

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Zusammenfassung

Achillessehnenrupturen (ASR) sind mit zunehmender Tendenz die häufigsten Sehnenrupturen der unteren Extremität, wohingegen weniger als 100 Fälle von Tibialis-anterior-Sehnenrupturen (TASR) in der Literatur beschrieben wurden. Beiden Sehnen gemeinsam sind die in der Regel degenerativ verursachten Rupturen in einem dafür anfälligen Sehnenabschnitt, wohingegen die traumatischen Durchtrennungen selten und ohne Ortsbeziehung vorkommen. Triceps surae und Tibialis anterior sind hauptverantwortlich für die sagittale Bewegung im oberen Sprunggelenk und führen bei Ruptur zu einem unverwechselbaren funktionellen Defizit. Trotzdem werden ASR in bis zu 25% und der TASR noch häufiger verspätet diagnostiziert.

Die frühzeitige primäre Naht hat die besten funktionellen Ergebnisse. Durch zunehmende Retraktion und Muskelatrophie kann eine verspätete chirurgische Sehnenrekonstruktion nur ein weniger gutes funktionelles Resultat erreichen. Jedoch braucht nicht jeder Patient eine volle Belastbarkeit, Kraft und Ausdauer dieser Muskeln und so dürfen konservative Maßnahmen nicht vergessen werden. Inaktive Patienten mit eingeschränktem Allgemeinzustand und geringen Beschwerden sollten aufgeklärt werden, dass die chirurgische Therapie der TASR eine hohe Rerupturrate aufweist und der ASR selten transplantationspflichtige Wundheilungsstörungen verursachen kann.

Abstract

Achilles tendon ruptures (ATR) are becoming the most frequent tendon rupture of the lower extremity, whereas less than 100 cases of tibialis anterior tendon ruptures (TATR) have been reported. Common in both tendons are the degenerative causes of ruptures in a susceptible tendon segment, whereas traumatic transections occur at each level. Triceps surae and tibialis anterior muscles are responsible for the main sagittal ankle range of motion and ruptures lead to a distinctive functional deficit. However, diagnosis is delayed in up to 25% of ATR and even more frequently in TATR.

Early primary repair provides the best functional results. With progressive retraction and muscle atrophy delayed tendon reconstruction has less favourable functional results. But not all patients need full capacity, power and endurance of these muscles and non-surgical treatment should not be forgotten. Inactive patients with significant comorbidities and little disability should be informed that surgical treatment of TATR is complicated by high rates of rerupture and surgical treatment of ATR can result in wound healing problems rarely necessitating some kind of transplantation.

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Authors and Affiliations

  1. Behandlungszentrum Bewegungsapparat, Orthopädische Universitätsklinik, Universitätsspital Basel, Spitalstraße 21, CH-4031, Basel, Schweiz

    G. Pagenstert, A. Leumann, A. Frigg & V. Valderrabano

Authors
  1. G. Pagenstert
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  2. A. Leumann
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  3. A. Frigg
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  4. V. Valderrabano
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Correspondence to G. Pagenstert.

Zusatzmaterial online

Video 1 - Klinische Befunde und Untersuchung bei Achillessehnenruptur (QuickTime Video 3,8 MB)

Video 2 - V-Y-Achillessehnenplastik mit Krackow-Naht bei 8cm Defekt (QuickTime Video 6,7 MB)

132_2010_1691_MO3_ESM.mov

Video 3 - Operationsschritte und postoperative Funktion nach Tibialis posterior auf Tibialis anterior Sehnentransfer beim Fallfuss (QuickTime Video 2,3 MB)

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Pagenstert, G., Leumann, A., Frigg, A. et al. Achillessehnen- und Tibialis-anterior-Sehnenruptur. Orthopäde 39, 1135–1147 (2010). https://doi.org/10.1007/s00132-010-1691-4

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  • DOI: https://doi.org/10.1007/s00132-010-1691-4

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