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Ersatz des vorderen Kreuzbandes beim Kind

Bereits Standard?

ACL reconstruction in children

Already standard?

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Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Die Inzidenz der kindlichen vorderen Kreuzbandruptur steigt aufgrund der zunehmenden Teilnahme an Risikosportarten auch in jüngeren Altersstufen an.

Therapie

Die konservative Therapie der kindlichen ligamentären VKB-Verletzung (VKB: vorderes Kreuzband) galt über lange Jahre wegen der Bedenken, durch eine Epiphysenfugenverletzung im Rahmen einer operativen Therapie Wachstumsstörungen zu verursachen, als Standard. In vielen Studien wurde belegt, dass der konservative Therapieansatz bei persistierender Instabilität zu einem schlechteren klinischen Outcome mit frühzeitigen, teils irreparablen Folgeschäden an Menisken und Knorpel führt. Daher wird heute bei aktiven Kindern und Jugendlichen mit klinischen Instabilitätszeichen die operative Bandrekonstruktion favorisiert. Verschiedene fugenaussparende und -kreuzende Operationstechniken wurden entwickelt und deren gute Ergebnisse durch Studien belegt.

Schlussfolgerung

Die epipyhsenkreuzende VKB-Plastik mit Hamstringsehnen führt unter Beachtung bestimmter operationstechnischer Prinzipien zu sehr guten und sichereren Ergebnissen ohne – im Vergleich zu den fugenaussparenden Techniken – erhöhte Rate an Wachstumsstörungen auch in jüngeren Altersstufen. Sie ist als Standardoperationstechnik in der Hand des erfahrenen Kreuzbandchirurgen auch beim Kind etabliert.

Abstract

Background

The rupture of the anterior cruciate ligament (ACL) in adolescent patients shows an increasing prevalence because of increased participation in high-risk sports in younger ages.

Therapy

For many years conservative treatment has been standard because of fear of growth disturbances due to physeal injury during surgery. However, many studies showed poor outcome for conservative treatment in skeletally immature patients with ALC instability and high rates of early intra-articular damage to menisci and cartilage. Therefore, even in adolescent patients operative reconstruction is favored. Several physeal sparing and transphyseal reconstruction techniques have been described and their good results have been proven in many studies.

Conclusion

The transphyseal ACL reconstruction with hamstring tendons provides excellent and safe results without higher risk of growth disturbances even in younger children. Certain technical principles during surgery have to be taken in account.

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Authors and Affiliations

  1. Abteilung Sportorthopädie, Knie- und Schulterchirurgie, BG-Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland

    F. Welsch, A.P. Mehling, T. Stein & R. Hoffmann

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  1. F. Welsch
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  2. A.P. Mehling
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  3. T. Stein
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  4. R. Hoffmann
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Correspondence to F. Welsch.

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Welsch, F., Mehling, A., Stein, T. et al. Ersatz des vorderen Kreuzbandes beim Kind . Trauma Berufskrankh 15 (Suppl 2), 204–211 (2013). https://doi.org/10.1007/s10039-013-1943-8

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