Zusammenfassung
Der natürliche Verlauf vorderer Kreuzband- (VKB-)Rupturen bei Kindern hat aufgrund der hohen Rate an sekundären Meniskusläsionen und der Entwicklung einer Früharthrose eine ungünstige Prognose. Obwohl diese Verletzungen insgesamt relativ selten sind, ist in den letzten Jahren eine Zunahme zu beobachten gewesen. Ihre Therapie wird in der Literatur kontrovers diskutiert, insbesondere die systematische langfristige konservative Behandlung wird derzeit kontestiert. Neuere Beobachtungen haben gezeigt, dass VKB-Plastiken bei Kindern auch in der präpubertären Phase zu guten klinischen Ergebnissen und bei technisch korrekter Durchführung der Operation unter Berücksichtigung der speziellen Anatomie des wachsenden Kniegelenks kaum zu klinisch relevanten Wachstumsstörungen führen. In die Indikationsstellung sollten die Ansprüche des Patienten und das Komplikationspotenzial mit einfließen. Die Wahl des operativen Verfahrens sollte der Anatomie und dem Wachstumsverhalten des kindlichen Kniegelenks Rechnung tragen. Dementsprechend hoch sind die Ansprüche an den Operateur, der eine große Erfahrung auf dem Gebiet der Kreuzbandchirurgie mitbringen sollte. Dieser Übersichtsbeitrag stellt die Empfehlungen zur Behandlung kindlicher Kreuzbandrupturen unter dem Licht der neuesten Erkenntnisse dar.
Abstract
The natural history of ligamentous tears of the anterior cruciate ligament (ACL) in children is unfavourable because of the high number of secondary meniscus lesions and early manifestation of osteoarthritis. Although their incidence still is relatively small, the number of ACL tears in children has increased over the last years. There is controversy about the treatment of these lesions, especially considering the long-term conservative approach. Recent studies have shown that ACL reconstructions in children can yield good clinical results and few complications if performed in a technically correct way with respect to the specific anatomy of childrens knees – even before puberty. The functional demands of the patient and the complication potential should be considered while indicating the procedure. A precise knowledge of the anatomical specificities of the childs knee and a large experience in ACL reconstruction surgery should be mandatory when taking care of these injuries. The present review gives a current overview of the management of these lesions in pre-adolescent children.
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Wilmes, P., Lorbach, O., Chotel, F. et al. Ersatzplastik des vorderen Kreuzbandes bei offenen Wachstumsfugen. Arthroskopie 22, 35–44 (2009). https://doi.org/10.1007/s00142-008-0502-y
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DOI: https://doi.org/10.1007/s00142-008-0502-y