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Periphere Instabilitäten bei Läsion des hinteren Kreuzbandes

Associated peripheral instabilities in PCL injuries

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Der zunehmende Wissensstand über Pathomechanismus, Diagnostik und Therapie von Verletzungen des hinteren Kreuzbandes (HKB) verstärkt im gleichen Maße das Interesse an den begleitenden peripheren Läsionen des Kniegenks. Verletzungen wie z. B. der Kollateralbänder, der posteromedialen oder posterolateralen Gelenkecke beeinflussen maßgeblich den Behandlungserfolg von HKB-Verletzungen.

Die genaue Kenntnis der Anatomie, Biomechanik und des pathophysiologischen Bewegungsablaufs peripherer Knieinstabilitäten ist Grundvoraussetzung für eine suffiziente Behandlung. Unter Einbeziehung des Unfallhergangs und Anamnese ist die klinische Untersuchung die Grundlage für das spätere Therapiekonzept.

Die Verletzung muss in ihrem Ausmaß erfasst und klassifiziert werden. Dabei sind insbesondere isolierte von kombinierten Verletzungen sowie gerade von rotatorischen Instabilitäten zu unterscheiden. Neben den Entscheidungskriterien wie Art der Instabilität (isoliert/kombiniert) und Dauer der Verletzung (akut/chronisch) sind weitere Faktoren, wie z. B. Beinachse und Alter des Patienten zu berücksichtigen.

Die Verletzungen des kollateralen Bandapparats dürfen nicht zusammengefasst beurteilt werden, da Unterschiede im Heilungspotenzial von Verletzungen des medialen und lateralen Bandapparats bestehen. Zudem sind die Erfolgsausichten der chronischen Rekonstruktion sehr unterschiedlich.

Diese Arbeit soll Einblicke in die Unfallmechanismen und Biomechanik peripherer Knieläsionen geben und auf diagnostische Schwierigkeiten hinweisen. Hiermit möchten wir ein differenziertes Behandlungskonzept auf der Basis unserer Erfahrung unter Berücksichtigung der internationalen Literatur vorstellen.

Abstract

The increasing knowledge of the pathomechanisms, diagnostic investigations, and treatment options of posterior cruciate ligament (PCL) injuries has shown the importance of additional peripheral knee ligament injuries that increase posterior translation and rotational instability. The success of PCL injury treatment is influenced by lesions for example of the collateral ligament, the posteromedial corner, or posterolateral corner.

A detailed understanding of the anatomy, the biomechanics and the pathophysiological motion sequence is crucial for adequate treatment of those injuries. To establish a treatment concept, the clinical examination requires a precise understanding of the trauma sequence and the medical history of the patient in order to anticipate possible injuries of the respective structures. For the exact evaluation of those injuries, isolated and combined as well as straight and rotatory instabilities have to be distinguished. Besides the injury criteria such as isolated vs combined and acute vs chronic, there are several other factors to be considered like the mechanical weight-bearing axis and the age of the patient.

Not all peripheral knee injuries should be grouped together, due to the difference in healing potential between injuries on the medial side and those on the lateral side. In addition the chance of success for reconstructions of chronic instabilities is substantially different from acute cases.

In this study we describe a comprehensive insight into injury mechanisms and biomechanics of peripheral instabilities. Furthermore, diagnostic problems with respect to clinical examination and imaging techniques are mentioned. We would like to present a differentiated treatment concept based on our experiences and data from the international literature.

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  1. Sektion Sporttraumatologie und Arthroskopie am Centrum für muskuloskelettale Chirurgie, Charité – Universitätsmedizin/Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 , Berlin, Deutschland

    T. M. Jung, A. Schmeling &  A. Weiler

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  1. T. M. Jung
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  2. A. Schmeling
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  3. A. Weiler
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Correspondence to A. Weiler.

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Jung, T.M., Schmeling, A. & Weiler, A. Periphere Instabilitäten bei Läsion des hinteren Kreuzbandes. Arthroskopie 19, 265–276 (2006). https://doi.org/10.1007/s00142-006-0359-x

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