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Multiligamentäre Instabilitäten des Kniegelenkes bei Sportverletzungen

Ein Update zum „Hamburger Konzept“

Multiligament instabilities of the knee in sports injuries

An update of the Hamburg concept

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Zusammenfassung

Hintergrund

Die Knieluxation (KL) ist eine seltene, aber schwere Verletzung des Kniegelenkes, mit einer hohen Rate neurovaskulärer Begleitverletzungen. Neben der Erfassung verletzter Bandstrukturen gemäß der Schenck-Klassifikation spielen der Verletzungsmechanismus, Begleitverletzungen und individuelle Faktoren eine wichtige Rolle für die Behandlungsstrategie.

Versorgungsstrategien

Bei der operativen Versorgungsstrategie ist auch zwischen „High-velocity“(HV)- und „Low-velocity“(LV)-Verletzungen zu unterscheiden. In der Regel wird eine primäre Versorgung innerhalb von 7–10 Tagen angestrebt. Die einzeitige Hybridversorgung mittels augmentierter Bandnähte („ligament bracing“), in Kombination mit primären Bandplastiken oder -augmentationen (posterolateral und VKB) führt zu sehr guten funktionellen Ergebnissen. „Ultra-low-velocity“(ULV)-Verletzungen und KL mit begleitender Peroneusläsion erfordern ob ihrer limitierten Prognose eine modifizierte Vorgehensweise. Die Nachbehandlung bedarf engmaschiger Nachkontrollen und sollte gezielt frühfunktionell erfolgen. In ca. 20 % der Fälle ist eine frühe arthroskopische Arthrolyse mit hohen Erfolgsraten assoziiert.

Abstract

Background

Knee dislocation (KD) is a rare but severe injury of the knee joint, with a high rate of concomitant neurovascular injuries. The severity of the ligamentous injury, which is classified according to the Schenck classification, the mechanism of injury, concomitant injuries and individual factors determine the treatment strategy in KD.

Treatment strategy

Furthermore, a clear differentiation between high-velocity (HV) and low-velocity (LV) injuries is necessary. Generally, surgical treatment within 7–10 days should be aspired. Herein, the one-stage hybrid treatment using augmented ligament sutures (ligament bracing) in combination with primary ligament reconstruction (posterolateral and ACL) leads to very good functional results in the mid-term. Ultra-low-velocity (ULV) dislocations and those with concomitant peroneal lesions require a modified approach, due to a limited prognosis. During rehabilitation, the individual progress must be closely monitored and follow an early functional approach. In approximately 20% of all cases, early arthroscopic arthrolysis shows a high success rate.

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Abbreviations

BMI:

Body-Mass-Index

CPM :

„Continuous passive motion“

HKB :

Hinteres Kreuzband

HV :

„High-velocity“

IKDC :

International Knee Documentation Committee

KL :

Knieluxation

LCL :

Ligamentum collaterale laterale

LV :

„Low-velocity“

MCL :

Ligamentum collaterale mediale

ULV :

„Ultra-low-velocity“

VKB :

Vorderes Kreuzband

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Jannik Frings,  Matthias Krause &  Karl-Heinz Frosch

  2. Christian-Albrechts-Universität Kiel, Kiel, Deutschland

    Peter Behrendt

  3. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland

    Karl-Heinz Frosch

Authors
  1. Jannik Frings
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  2. Peter Behrendt
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  3. Matthias Krause
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  4. Karl-Heinz Frosch
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Correspondence to Jannik Frings.

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Interessenkonflikt

J. Frings, P. Behrendt, M. Krause und K.-H. Frosch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Frings, J., Behrendt, P., Krause, M. et al. Multiligamentäre Instabilitäten des Kniegelenkes bei Sportverletzungen. Orthopädie 52, 882–888 (2023). https://doi.org/10.1007/s00132-023-04438-7

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