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Die Apple-Bite-Fraktur – wann und wie versorgen?

The apple bite fracture—When and how should it be treated?

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Arthroskopie Aims and scope

Zusammenfassung

Posterolaterale Impressionsfrakturen der Tibia sind eine häufige Begleitverletzung bei Rupturen des vorderen Kreuzbands (VKB). Aufgrund des morphologischen Erscheinungsbilds hat sich hierfür der Begriff der Apple-Bite-Fraktur etabliert. Diese Frakturen gehen oftmals mit Verletzungen des Außenmeniskus und des Innenbandkomplexes einher und können je nach Schweregrad einen unabhängigen Risikofaktor für schlechtere postoperative Ergebnisse nach VKB-Rekonstruktion darstellen. Die Empfehlung zur operativen Versorgung richtet sich nach der Tiefe der knöchernen Impression und der Ausdehnung der Fraktur. Die meisten versorgungswürdigen Frakturen lassen sich minimal-invasiv, arthroskopisch unterstützt adressieren, wobei sich vor allem die retrograde Aufstößelung mit anschließender perkutaner Verschraubung in Jail-Technik etabliert hat. Die klinischen Ergebnisse zeigen sich hier vielversprechend, jedoch stehen valide wissenschaftliche Daten bezüglich der genauen Indikation zur operativen Versorgung der Apple-Bite-Fraktur noch aus.

Abstract

Posterolateral impression fractures of the tibia are a frequent comorbidity of ruptures of the anterior cruciate ligament (ACL). Because of the morphological appearance, the term “apple bite fracture” has become established. These fractures are often associated with additional injuries of the lateral meniscus and the medial ligament complex and, depending on the severity, are an independent risk factor for inferior postoperative results after ACL reconstruction. The recommendation for a surgical intervention depends on the depth of the bony impaction and the extent of the fracture. Most fractures which require surgery can be addressed by a minimally invasive procedure with arthroscopic assistance, for which in particular retrograde elevation followed by percutaneous screw fixation in the jail technique has become established. The clinical results show promise, however, valid scientific data regarding clear indications for surgical treatment of apple bite fractures are still missing.

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Authors and Affiliations

  1. Sektion Sportorthopädie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    Julian Mehl, Sebastian Siebenlist & Bastian Scheiderer

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  1. Julian Mehl
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  2. Sebastian Siebenlist
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  3. Bastian Scheiderer
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Correspondence to Julian Mehl.

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Interessenkonflikt

J. Mehl, S. Siebenlist und B. Scheiderer 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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S. Siebenlist, München

P. Lobenhoffer, Hannover

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Mehl, J., Siebenlist, S. & Scheiderer, B. Die Apple-Bite-Fraktur – wann und wie versorgen?. Arthroskopie 36, 96–102 (2023). https://doi.org/10.1007/s00142-023-00591-5

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  • DOI: https://doi.org/10.1007/s00142-023-00591-5

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