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Komplikationen arthroskopischer Eingriffe am Kniegelenk

Complications of knee arthroscopy

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Zusammenfassung

Hintergrund

Die Arthroskopie des Kniegelenks zählt heute zu den Standardeingriffen eines Orthopäden und ist in der Regel ein komplikationsarmer Eingriff.

Ziel der Arbeit

Der Operateur sollte dennoch die möglichen Komplikationen genau kennen und beherrschen und dem Patienten präoperativ ausführlich erläutern.

Material und Methoden

Es erfolgt eine Darstellung der möglichen relevanten peri-, intra- und postoperativen Komplikationen bei Kniegelenksarthroskopie.

Ergebnisse

Entscheidend für den Erfolg ist vor allem die Abschätzung von Vor- und Nebenerkrankungen des Patienten sowie eine korrekte Diagnose- und Indikationsstellung unter Zuhilfenahme entsprechender bildgebender Verfahren. Zu den peri- und intraoperativen Komplikationen zählen Nerven- und Gefäßverletzungen, Fehlanlage der Arthroskopieportale, Thrombosen, Luftembolien, Materialbruch und ein mögliches Kompartment-Syndrom. Im unmittelbaren postoperativen Verlauf sind die wichtigsten negativen Ereignisse Hämarthros, Thrombose, Embolie und Infekt sowie das Auftreten von Synovialfisteln. Im Falle eines Gelenkinfekts ist eine konsequente und frühzeitige Diagnostik und Therapie für den Gelenkerhalt entscheidend. Zu den wichtigsten Spätkomplikationen nach arthroskopischen Eingriffen gehören der Morbus Ahlbäck, die Arthrofibrose und das CRPS-Syndrom (complex regional pain syndrome).

Diskussion

Eine systematische Ausbildung arthroskopischer Chirurgen an Simulatoren, Modellen und in Kadaverkursen als auch durch Hospitationen bei erfahrenen Arthroskopeuren ist heutzutage zu fordern, um den Patienten die bestmögliche Therapie anbieten zu können.

Abstract

Background

Today, knee arthroscopy is one of the standard interventions performed by an orthopaedist and usually has a low potential for complications.

Purpose

The surgeon should still be aware of possible problems, and be able to control and explain them to the patient in detail before surgery.

Materials and methods

The possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed.

Results

Evaluation of the patient’s medical history and comorbidities is crucial to successful treatment, in addition to a correct diagnosis and indications with the assistance of appropriate imaging procedures. Nervous and vascular injuries, malplacement of arthroscopy portals, thrombosis, air embolism, material breakage and a possible compartment syndrome constitute the peri-and intraoperative complications. Postoperatively, the most frequent negative events are haemarthrosis, thrombosis, embolism and infection, and the appearance of synovial fistulas.

In the case of a joint infection, consistent and immediate diagnosis and therapy are vital for joint preservation. Late complications after arthroscopic interventions include Ahlback’s disease, arthrofibrosis and complex regional pain syndrome (CRPS).

Discussion

Nowadays, the systematic education of arthroscopic surgeons using simulators, models, and cadavers, in addition to shadowing experienced arthroscopists, is required to offer patients the best therapeutic options.

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  1. OCM-Klinik, Steinerstr. 6, 81369, München, Deutschland

    H.O. Mayr & A. Stoehr

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H.O. Mayr und A. Stoehr geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Mayr, H., Stoehr, A. Komplikationen arthroskopischer Eingriffe am Kniegelenk. Orthopäde 45, 4–12 (2016). https://doi.org/10.1007/s00132-015-3182-0

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