Z Orthop Unfall 2013; 151(4): 380-388
DOI: 10.1055/s-0032-1328692
Kinderorthopädie
Georg Thieme Verlag KG Stuttgart · New York

Aktuelle diagnostische und therapeutische Vorgehensweise bei der primären und rezidivierenden Patellaluxation – Analyse einer bundesweiten Umfrage und der aktuellen Literatur

Diagnostic and Therapeutic Management of Primary and Recurrent Patellar Dislocations – Analysis of a Nationwide Survey and the Current Literature
J. Hohlweck
1   Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
,
V. Quack
1   Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
,
D. Arbab
1   Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
,
C. Spreckelsen
2   Institut für Medizinische Statistik, Universitätsklinik RWTH Aachen, Aachen, Deutschland
,
M. Tingart
1   Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
,
C. Lüring
1   Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
,
B. Rath
1   Klinik für Orthopädie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
20 August 2013 (online)

Zusammenfassung

Studienziel: Patellaluxationen sind eine häufige Verletzungsart des Kniegelenks. Bei der Erstluxation können Begleitschäden auftreten, die im Verlauf zu einer rezidivierenden Luxation führen können. Zudem gibt es kongenitale Pathologien, die eine Patellaluxation prädisponieren. In der aktuellen Literatur werden die Diagnostik und die Therapie bei Patellaluxationen zunehmend diskutiert. Ziel unserer Umfrage an deutschen Kliniken war es daher, die aktuellen Versorgungsstrategien in Deutschland zu erfassen und mit der aktuellen Literatur zu diskutieren. Methode: 735 orthopädische und/oder unfallchirurgische Kliniken wurden eingeladen, an einer anonymen Umfrage zur Diagnostik und Therapie bei primärer und rezidivierender Patellaluxation teilzunehmen. Der Fragebogen bestand aus Multiple-Choice-Fragen und war in 3 Abschnitte unterteilt. Ein systematisches Literaturreview wurde zudem durchgeführt. Ergebnisse: 245 Kliniken (33,3 %) nahmen an der Umfrage teil. Sowohl bei Erst- als auch bei Reluxationen der Patella war die klinische Untersuchung für die Teilnehmer von großer Bedeutung. Zudem wurde eine MRT-Untersuchung in über 80 % bei der primären und rezidivierenden Patellaluxation durchgeführt. Konventionelle Röntgenaufnahmen wurden in über 50 % initiiert. Bei der primären Patellaluxation war die konservative Therapie die häufigste genannte Maßnahme, gefolgt von der Raffung des medialen Retinaculums und der MPFL-Plastik (MPFL: mediales patellofemorales Ligament). Bei rezidivierenden Patellaluxationen war die MPFL-Plastik an erster Stelle der gewählten Therapieformen. Zudem wurde ein Versatz der Tuberositas tibiae ebenfalls häufig durchgeführt. Schlussfolgerung: In Übereinstimmung mit der aktuellen Literatur konnte die klinische Bedeutung der MPFL-Plastik bei primären und besonders bei rezidivierenden Patellaluxationen aufgezeigt werden. Zudem ist die konservative Therapie weiterhin die häufigste Therapieform bei der primären Patellaluxation.

Abstract

Aim: Patellar dislocations are a common injury of the knee joint. During patella dislocations injuries of soft-tissue structures can occur that can destabilise the patella and lead to recurrent dislocations. There are also congenital pathologies that predispose to patella dislocations. In the current literature, diagnostics and treatment of patellar dislocations are frequently discussed. Therefore the aim of our survey was to analyse and summarise actual diagnostic and therapeutic strategies regarding primary and recurrent patella dislocations. Methods: An online questionnaire form was sent to 735 orthopaedic and/or trauma departments in Germany. The departments were invited to participate in an anonymous survey concerning diagnostics and treatment of primary and recurrent patellar dislocations. The questionnaire consisted of multiple choice questions and was divided into three sections. The first section included questions concerning the department structure. The second part contained questions regarding diagnostics and treatment of primary patella dislocations. The third part involved diagnostic and treatment strategies for recurrent patella dislocations. A systematic review of outcome after treatment of patellar dislocation was performed and discussed with the results of the survey. Results: 245 hospitals (33.3 %) returned the questionnaire. Among the participants were 23 % orthopaedic surgery departments, 32 % trauma surgery departments and 45 % combined departments. 12 % were university hospitals and 53 % academic teaching hospitals. Clinical examination was performed by nearly all participants after primary and recurrent patella dislocations. MRI was used as diagnostic tool in 81 % after primary patella dislocation and in 85 % after recurrent patella dislocation. Conventional X-rays were performed in 58 % (primary) and 51 % (recurrent patella dislocations). Computed tomography scans for measurement of the tuberositas tibiae–trochlea groove distance were used in 35 % after recurrent dislocations and in 20 % after primary patella dislocations. 69 % of the participating departments performed non-operative therapies after primary patella dislocations, especially when no associated injuries and no congenital pathologies were observed. Reconstruction of the medial retinaculum was the most frequent surgical therapy (52 %) followed by the reconstruction of the medial patellofemoral ligament (36 %) after primary patella dislocation. Following recurrent patella dislocations reconstruction of the medial patellofemoral ligament (58.5 %) was the most performed surgery and a tuberositas transfer was done in 58 % of participating departments after recurrent patella dislocation. Conclusion: The results of our survey showed diagnostic and therapeutic procedures in the participating departments which are in accordance with recommendations in recent publications. The clinical importance of the MPFL reconstruction was observed for primary and recurrent patella dislocation. In addition, conservative treatment is still the most common treatment after primary dislocation of the patella.

 
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