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Einfluss des knöchernen Alignments auf den Bandapparat des Kniegelenks

Influence of the bony alignment on the ligaments of the knee joint

  • Leitthema
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Zusammenfassung

Die Ausrichtung der unteren Extremitäten im dreidimensionalen Raum wird als Alignment bezeichnet. Biomechanische und klinische Studien konnten in den letzten Jahren zeigen, dass das knöcherne Alignment einen relevanten Einfluss auf den Bandapparat und auf die Stabilität des Kniegelenks hat. Im Fall von ligamentären pathologischen Schäden am Kniegelenk sollte ein mögliches Malalignment daher immer auch diagnostisch beurteilt und ggf. in die Therapieplanung einbezogen werden. Ein varisches Malalignment spielt v. a. im Hinblick auf die Kreuzbänder und die posterolateralen Bandstrukturen eine wichtige Rolle und konnte als Risikofaktor für das Versagen einer Rekonstruktion dieser Bandstrukturen identifiziert werden. Auch für das valgische Malalignment gibt es ähnliche Daten v. a. im Hinblick auf das vordere Kreuzband und den medialen Kapselbandapparat. Abweichungen in der Sagittalebene, und hier v. a. die Inklination der tibialen Gelenkfläche („slope“), sind mittlerweile gut untersucht und haben einen relevanten Einfluss auf die anteroposteriore Stabilität des Kniegelenks und auf die Kreuzbänder. Erste klinische Studien zu operativen Achskorrekturen im selektierten Patientenkollektiv zeigten vielversprechende Ergebnisse mit dem Potenzial, Bandrekonstruktionen vor einem erneuten Versagen zu schützen. Weitere Daten v. a. im Hinblick auf den Stellenwert und die genaue Indikationsstellung einer zusätzlichen Achskorrektur sind jedoch notwendig.

Abstract

In recent years biomechanical and clinical studies have shown that the three-dimensional bony alignment of the lower extremities has a relevant influence on the ligamentous structures of the knee and consequently on the stability of the knee joint. Therefore, in the case of pathological ligamentous damage of the knee joint, a possible malalignment must always be thoroughly evaluated and if necessary, included in the treatment planning. Varus malalignment plays an important role especially with respect to the cruciate ligaments as well as the posterolateral ligamentous structures and has been identified as a significant risk factor for failure after surgical reconstruction of these ligamentous structures. Similar data have also been published for valgus malalignment particularly with respect to its negative influence on the anterior cruciate ligament and the medial capsuloligamentous complex. Alignment deviations in the sagittal plane, especially the inclination of the tibial articular surface (slope), have been extensively investigated in several recent studies. It has been demonstrated that the tibial slope has a relevant influence on the anteroposterior stability of the knee joint and hence on the cruciate ligaments. First clinical studies on the surgical correction of the axis in selected patients showed very promising results with the potential of protecting ligament reconstructions against repeated failure; however, further data especially regarding the importance and the exact indications for an additional alignment correction are necessary.

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  1. Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    Julian Mehl & Sebastian Siebenlist

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J. Mehl führt beratende Tätigkeiten für Arthrex GmbH und Ormed GmbH durch. S. Siebenlist ist Berater für Arthrex GmbH, medi Gmbh & Co. KG sowie KLS Martin Group.

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

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Mehl, J., Siebenlist, S. Einfluss des knöchernen Alignments auf den Bandapparat des Kniegelenks. Unfallchirurgie 127, 27–34 (2024). https://doi.org/10.1007/s00113-023-01363-4

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