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Bandverletzungen am oberen Sprunggelenk

  • Leitthema
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Trauma und Berufskrankheit

Zusammenfassung

Persistierende Bandinstabilitäten am oberen Sprunggelenk führen zu chronischen Synovitiden, Knorpelläsionen und osteophytären Anbauten im Sinne einer präarthrotischen Deformität. Verletzungen der distalen tibiofibularen Syndesmose werden bei einer Ruptur des Lig. tibiofibulare interosseum relevant. Die exakte Reposition der Fibula in die Tibiainzisur und temporäre Stellschraubenfixation sind Voraussetzung für eine anatomische Ausheilung. Zur Therapie der chronischen Syndesmoseninsuffizienz wird eine anatomische Bandplastik bevorzugt. In der Behandlung frischer fibularer Bandrupturen hat sich in den letzten 20 Jahren das Konzept der konservativ-funktionellen Therapie etabliert. Auch in neueren Metaanalysen konnten keine klaren Vorteile der zudem mit Komplikationen behafteten operativen Therapie herausgearbeitet werden. Chronische Bandinstabilitäten können mit guter Prognose sekundär operativ versorgt werden, wobei den anatomischen Rekonstruktionen eindeutig der Vorzug gegenüber extraanatomischen Tenodesen zu geben ist, da Letztere mit unphysiologischen Restriktionen behaftet sind. Die eher seltenen isolierten Verletzungen des Lig. deltoideum heilen bei korrekter Diagnosestellung unter konservativ-funktioneller Behandlung problemlos aus.

Abstract

Ligamentous instability in the ankle frequently leads to chronic synovitis, cartilage lesions and osteophyte formation, which may degenerate into posttraumatic arthritis. Lesions of the distal tibiofibular syndesmosis are significant for the biomechanics of the ankle when the interosseous tibiofibular ligament is ruptured. Accurate reduction of the fibula to reposition it in the tibial incision and temporary fixation with a syndesmosis screw are essential if healing in the anatomical position is to be achieved. For treatment of a chronic instability of the distal tibiofibular syndesmosis anatomical ligamentoplasty is preferred. In the case of acute lateral ankle ligament ruptures conservative-functional treatment has become established over the last 20 years. Recent meta-analyses have failed to demonstrate any clear superiority of operative treatment, which has the potential for considerable complications. Chronic lateral ankle instability has a favorable prognosis with secondary interventions. Anatomical reconstruction should be given priority over extra-anatomical tenodesis procedures, since the latter are associated with considerable functional restrictions. Isolated ruptures of the deltoid ligaments are rare injuries that heal well with conservative-functional treatment after correct diagnosis.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden

    Stefan Rammelt, René Grass, Achim Biewener & Hans Zwipp

  2. Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 , Dresden

    Stefan Rammelt

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  1. Stefan Rammelt
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  2. René Grass
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  3. Achim Biewener
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  4. Hans Zwipp
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Correspondence to Stefan Rammelt.

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Rammelt, S., Grass, R., Biewener, A. et al. Bandverletzungen am oberen Sprunggelenk. Trauma Berufskrankh 5, 170–178 (2003). https://doi.org/10.1007/s10039-003-0730-3

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