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Läsionen des Lig. capitis femoris

Pathologie und Therapie

Lesions of the ligament of the femur head

Pathology and therapy

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Obwohl die Entwicklung des Lig. capitis femoris (im Deutschen auch oft Lig. teres genannt) sehr gut bekannt ist, gibt es über die Funktion beim Erwachsenen bisher keine Erkenntnisse. Weil sich das Band in Adduktion, Flexion und Außenrotation am meisten anspannt, kann es in einer solchen forcierten Bewegung auch reißen. Bei Sportarten mit einem starken Bewegungsausschlag der Hüfte kommen solche Rupturen gehäuft vor. Die Inzidenz schwankt zwischen 8 und 17% je nach Literatur. Die Selbstheilung dieses Bandes konnte nachgewiesen werden, sodass die konsekutive Narbenbildung zwischen Fossaboden und Kopf einklemmen kann. Dieses foveale Impingement ist verantwortlich für ein schmerzhaftes Hüftgelenk, wenn ansonsten keine anderen Deformationen oder Degenerationen vorhanden sind, insbesondere wenn die Schmerzen nach einem plötzlichen Verdrehen des Hüftgelenks eingesetzt haben. Anamnese und spezifische Untersuchung sind für die Diagnostik die wichtigsten Faktoren, weil das MRT eine geringe Spezifität aufweist.

Bis heute besteht die Therapie der Wahl in der Resektion oder Trimmung des Ligaments mit eventueller Fossaerweiterung zur Vermeidung eines weiteren Impingements. Zur Diagnostik wird dabei der laterale Zugang verwendet und zur Resektion oder Trimmung der vordere und der hintere Zugang. Eine Hochfrequenzablationselektrode ist dabei unabdingbar, vorzugsweise eine, die beweglich ist. Die Resultate nach einer solchen Trimmung oder Resektion sind als sehr gut zu bezeichnen und erhöhen den Harris Hip Score (HHS) von 47 auf über 90 gemäß der einzigen Studie von Byrd. Viele Einzelfallbeschreibungen verstärken diesen Eindruck, wenn die Diagnose tatsächlich korrekt war.

Weitere Untersuchungen werden zeigen müssen, welche genaue Funktionen dieses VKB-ähnliche Band beim Erwachsenen hat und in wieweit eine Rekonstruktion erforderlich werden kann.

Abstract

Despite the fact that the evolution and development of the ligament of the head of the femur is very well known, the function of this ligament is still unknown in adults. The ligament is tensioned in flexion, adduction and outer rotation of the hip joint. There is a particularly high incidence of ruptures of this ligament in sports where strong rotational movements of the hips are needed. Overall the incidence of ruptures is between 8 and 17% according to the literature. A self-healing response of the ligament could be proven and therefore subsequent formation of scar tissue in the fovea which leads to an impingement in the fovea causing pain. This foveal impingement can be seen in MRI, but there is a low specificity and sensitivity. The history and a thorough clinical examination are more specific and therefore more important for the diagnosis.

The current therapy of choice is reduction or resection or trimming of the ligament and possibly additional extension of the fovea to avoid further impingement. The lateral approach is used for diagnostics, whereas the anterior and the posterior approaches are used to insert the instruments. A high-frequency electrode is mandatory and a flexible one can be very helpful. The results of trimming are excellent according to the only study by Byrd and the Harris Hip Score (HHS) is increased from 47 to 90. There are numerous case reports in the literature which support these excellent results if the diagnosis is correct.

More studies are needed to evaluate the function of this ligament, which resembles the anterior cruciate ligament, in adults and to what extent reconstruction of this ligament can be justified.

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Lampert, C. Läsionen des Lig. capitis femoris. Arthroskopie 22, 293–298 (2009). https://doi.org/10.1007/s00142-009-0521-3

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