Zusammenfassung
Für die Behandlung der Patellaluxation wurden in der Vergangenheit multiple Behandlungskonzepte beschrieben. Beim undifferenzierten operativen Vorgehen kommt es zu hohen Reluxationsraten. Durch Berücksichtigung der entsprechenden Pathologien können die Reluxationsraten deutlich reduziert und das klinische Outcome verbessert werden. Der Therapiealgorithmus sollte deshalb die Entitäten Patellainstabilität, Patellamaltracking und Verlust des Patellatrackings unterscheiden, um ein individuelles, der Pathologie angepasstes Therapieregime einleiten zu können. In der vorliegenden Arbeit wird speziell auf Achsen- und Torsionsdeformitäten als Ursachen für das Patellamaltracking eingegangen. Dabei spielen jeweils das Genu valgum, die Innentorsionsdeformität des Femurs bzw. die Außentorsionsdeformität der Tibia eine wichtige Rolle. Neben einem Literaturüberblick über Achsenabweichungen und Torsionsdeformitäten als Ursache für das Patellamaltracking wird auch das Krankheitsbild des „inwardly pointing knee“ dargestellt und mit Fallbeispielen untermauert. Bei entsprechender Indikationsstellung und technisch korrekter Ausführung der spezifischen Osteotomien zur Wiederherstellung physiologischer Achsen- und Torsionsverhältnisse werden in der Literatur gute Ergebnisse mit niedrigen Komplikationsraten präsentiert.
Abstract
Multiple treatment concepts for patella dislocations have been described in the past. Redislocation rates are high if undifferentiated therapies are applied. Redislocation rates can be significantly reduced and clinical outcome improved, if underlying pathologies are respected. Entities such as patella instability, patella maltracking and loss of patellar tracking should thus be differentiated, to create an individualised treatment algorithm adapted to the patient’s pathology. The current review focuses on angular and torsional deformities of the leg as causes of patella maltracking. In this context, genu valgum, internal torsion of the femur and external torsion of the tibia are important pathologies. Besides an overview of the current literature on pathological knee base lines as causes of patellar maltracking, the clinical entity „inwardly pointing knee“ is also presented and discussed on the basis of case examples. Without exception among reports in the literature, when used to treat the corresponding indication, correct technical application of the specific osteotomy to regain physiological angular and torsional conditions achieves good and excellent clinical results.
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K.-H. Frosch, R. Akoto, M. Heitmann und A. Preiss geben an, dass kein Interessenkonflikt besteht.
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F. Dirisamer, Linz-Puchenau
A. Schmeling, Berlin
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Frosch, KH., Akoto, R., Heitmann, M. et al. Patellofemorale Instabilität. Arthroskopie 28, 194–201 (2015). https://doi.org/10.1007/s00142-015-0020-7
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DOI: https://doi.org/10.1007/s00142-015-0020-7