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Sportverletz Sportschaden 2021; 35(04): 185-193
DOI: 10.1055/a-1667-2241
Übersicht

Akute und chronische Patellainstabilität – Empfehlungen zur Diagnostik, Risikostratifizierung und Therapie

Primary and recurrent patellar dislocation: recommendation for diagnostic evaluation, risk stratification and treatment
Peter Balcarek
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Zusammenfassung

Das Dogma der rein konservativen Therapie der Patella-Erstluxation gilt als überholt. Daher sollte die Erstluxation, wie auch die Rezidivluxation, umfassend bezüglich des Verletzungsmusters und der anatomisch-prädisponierenden Risikofaktoren diagnostiziert werden. Dies ermöglicht die Anwendung von Risikostratifizierungsmodellen zur Beurteilung des Rezidivrisikos einer Luxation und kann damit die therapeutische Entscheidungsfindung unterstützen. Die MPFL-Plastik hat sich als erfolgreiche Therapie zur Behandlung der Patellainstabilität etabliert. Jedoch ist oftmals eine ergänzende Korrektur knöcherner Risikofaktoren notwendig bzw. empfehlenswert. Dabei kommt der präoperativen Ausprägung des J-Signs und der dynamischen Beurteilung der Patellainstabilität (dynamischer Apprehension-Test) entscheidende Bedeutung zu, die in der Kombination mit den Befunden der Bildgebung die Entscheidungsgrundlage für eine knöcherne Korrektur darstellen.

Abstract

The dogma that (every) primary patellar dislocation should be treated non-operatively is considered outdated. Therefore, every first-time dislocation, as well as every recurrent dislocation, should be fully diagnosed with regard to the injury pattern and anatomically predisposing risk factors. This enables the use of risk stratification models to assess the risk of recurrent episodes of instability, thereby supporting the clinical decision-making process. The reconstruction of the MPFL can be considered an established and successful treatment strategy for patellar instability. However, the additional correction of bony risk factors is often useful. In this context, the preoperative grading of the J sign and dynamic assessment of patellar instability (dynamic apprehension test) are of utmost importance. These findings, combined with the radiographic imaging findings, can be used as a clinical decision aid for a bony correction procedure.

Schlüsselwörter

Patella-Erstluxation - Patella-Rezidivluxation - Risikostratifizierung - Therapie

Key words

first-time patellar dislocation - recurrent patellar dislocation - risk stratification - surgical treatment.


Publikationsverlauf

Artikel online veröffentlicht:
09. Dezember 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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