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Rampenläsionen

Tipps und Tricks in Diagnostik und Therapie

Ramp lesions

Tips and tricks in diagnostics and therapy

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Zusammenfassung

Rampenläsionen sind häufig mit Verletzungen des vorderen Kreuzbands (VKB) vergesellschaftet und treten fast ausschließlich im Bereich des medialen Meniskus auf. Im Rahmen einer anterioren Routinekniegelenkspiegelung und durch die präoperative radiologische Diagnostik können sie nur eingeschränkt bis gar nicht diagnostiziert werden. Die klinische Relevanz dieser Läsionen ist noch nicht eindeutig geklärt. Neuere biomechanische Studien zeigen eine erhöhte anteroposteriore und rotatorische Laxität des Gelenks bei nicht reparierter Rampenläsion. Aufgrund dessen werden sie in Zusammenhang mit dem frühzeitigen Versagen von VKB-Ersatzplastiken gebracht. Die Inspektion des posteromedialen Kniegelenkkompartiments bei arthroskopisch gesicherter VKB-Verletzung über das Trans-notch-Portal und die Untersuchung der meniskokapsulären Strukturen mit dem Tasthaken über ein posteromediales Arbeitsportal sollten routinemäßig durchgeführt werden. Bei der Diagnose einer meniskosynovialen Läsion trägt die Reparatur zu einer signifikanten Verbesserung der Kniegelenklaxität bei und somit möglicherweise zu besseren Langzeitergebnissen bei gleichzeitig durchgeführter VKB-Ersatzplastik. Die Rekonstruktion der posteromedialen Strukturen ist technisch anspruchsvoll und wird arthroskopisch über ein oder zwei posteromediale Arbeitsportale durchgeführt.

Abstract

There is an increasing biomechanical and anatomical understanding of the different types of meniscal lesions. Lesions of the posterior part of the medial meniscus in the meniscosynovial area have recently received increased attention. They generally occur in association with anterior cruciate ligament (ACL) injuries. They are often missed (“hidden lesions”) due to the fact that they cannot be seen by routine anterior arthroscopic inspection. Furthermore, meniscosynovial lesions play a role in anteroposterior knee laxity and, as such, they may be a cause of failure of ACL reconstruction or of postoperative persistent laxity. Little information is available regarding their cause with respect to injury mechanism, natural history, biomechanical implications, healing potential and treatment options. This article presents an overview of the currently available knowledge of these ramp lesions, their possible pathomechanism, classification, biomechanical relevance as well as repair techniques.

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Abbreviations

IKDC:

International Knee Documentation Committee

MRT:

Magnetresonanztomographie

VKB:

Vorderes Kreuzband

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Authors and Affiliations

  1. Abt. für Orthopädische Chirurgie, Centre Hospitalier de Luxembourg – Clinique d’Eich, Akademisches Lehrkrankenhaus der Universitätskliniken des Saarlandes Homburg/Saar, 78, rue d’Eich, 1460, Luxembourg, Luxemburg

    R. Seil, A. Hoffmann, C. Mouton & D. Pape

  2. Sports Medicine Research Laboratory, Luxembourg Institute of Health, Centre Médical Norbert Metz, 76, rue d’Eich, 1460, Luxembourg, Luxemburg

    R. Seil, D. Theisen, C. Mouton & D. Pape

  3. Sportorthopaedicum Berlin, Bismarckstrasse 45–47, 10627, Berlin, Deutschland

    S. Scheffler

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  1. R. Seil
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  2. A. Hoffmann
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  4. D. Theisen
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  5. C. Mouton
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  6. D. Pape
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Correspondence to R. Seil.

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Interessenkonflikt

R. Seil, A. Hoffmann, S. Scheffler, D. Theisen, C. Mouton und D. Pape geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Seil, R., Hoffmann, A., Scheffler, S. et al. Rampenläsionen. Orthopäde 46, 846–854 (2017). https://doi.org/10.1007/s00132-017-3461-z

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