Verletzungen der proximalen Rectus-femoris- und Adductor-longus-Sehne

Zusammenfassung

Sehnenrupturen der proximalen Rectus-femoris- und Adduktorensehne sind in der breiten Bevölkerung zwar sehr selten, jedoch in Sportarten wie Fußball oder Sprinten aufgrund sportspezifischer und immer wiederkehrender Bewegungsabläufe häufiger und von großer Relevanz, da sie zu langen Ausfallzeiten bis hin zum Karriereende führen können.

Anatomisch sind der 2-gelenkige (diarthrodiale) Verlauf des M. rectus femoris (RF) und der lange Verlauf des M. adductor longus (AL), vom oberen Schambeinast zum dorsalen Femur, charakteristisch. Durch schnelle, kraftvolle Hüftflexionsbewegungen und abrupte Adduktionsbewegungen bei schnellen Richtungswechseln in diversen Sportarten sind beide Muskeln häufig von Verletzungen betroffen.

Die Anamnese und klinische Untersuchung sind meist wegweisend, eine anschließende bildgebende Diagnostik jedoch für beide Muskeln essenziell. Die Sonografie und die Magnetresonanztomografie (MRT) sind dabei der Goldstandard. Die Therapie kann sowohl konservativ als auch operativ durchgeführt werden und ist abhängig vom Schweregrad der Verletzung.

Eine konservativ behandelte RF-Ruptur birgt die Gefahr von persistierenden Beschwerden und einem relevanten Kraftdefizit bei Wiederaufnahme der sportlichen Belastung, weshalb bei sportlich hohem Anspruch die Indikation zur operativen Refixation großzügiger gestellt werden sollte.

Im Bereich der proximalen AL zeigt die operative Therapie nach derzeitigem Stand keinen Vorteil. Eine Besonderheit stellt der Apophysenabriss bei Kindern und Jugendlichen dar und bedarf nicht selten einer osteosynthetischen Versorgung.

Sehnenrupturen der proximalen Rectus-femoris- und Adduktorensehne sind typische Sportverletzungen und bedürfen zur vollständigen Wiederherstellung von Kraft und Funktion nebst klinisch-radiologischer Diagnostik einer kritischen und erfahrenen Beurteilung hinsichtlich der Art und Schwere der Verletzung sowie der Heilungschance in Bezug auf eine operative und nicht operative Behandlung, um Risiken wie persistierende Schmerzen und Funktionseinschränkungen zu vermeiden. Der folgende Themenbeitrag dient als Übersicht über aktuelle Behandlungsstrategien und deren Indikationsgrenzen.

Abstract

Traumatic tendon tears of the proximal rectus femoris (RF) and adductor longus tendon (AL) are rare in general population but more frequently observed in athletes e.g. soccer or sprinting due to sport-specific movements and relevant to long lasting downtimes.

For accurate diagnosis detailed knowledge of anatomy and kinematics are essential for better understanding of injury mechanism and individual treatment.

RF is the only biarthrodial muscle in the quadriceps complex and important in aforementioned athletes functioning as both as hip flexion and knee extension. Proximal RF injuries mainly occur in sprinting and kicking ball sports including components of forced hip flexion or eccentric hip extension. The AL originates from the upper ramus ossis pubis to the dorsi side of the femur. Injury mechanism of proximal AL tears typically involve combined forced hip abduction and hip extension with or without contact.

Detailed clinical examination and trauma history are often indicative to the type of injury.

Ultrasonography is a real-time evaluation and has practical advantages over magnetic resonance imaging (MRI) including instant availability and relatively low-cost equipment. However, MRI is the gold standard for evaluating RF and AL tendon injuries.

Optimal management of proximal RF and AL tendon tear injuries remain controversial due to limited numbers of studies with treatment outcomes.

In general, both nonoperative and operative treatment lead to good functional results. Awareness should be given to athletes in demanding sports whereas in cases with retracted tendon surgical treatment is more indicated than for others thus chronic pain and residual hip flexor weakness is common complication after nonoperative therapy.

Apophyseal avulsion fractures are special forms of traumatic tendon injuries in adolescents and children and are of higher risk according to fragment dislocation and bone healing disorders.

Non-union of pelvic apophysis should be considered in management. Greater dislocated fragments are indicated to surgical fixation in order to avoid bone healing disorders.

Schlüsselwörter

Sehnenruptur - proximale Rectus-femoris-Sehne - proximale Adduktor-longus-Sehne - operative Refixation - Sehnenretraktion

Keywords

proximal rectus femoris tendon injury - proximal adductor longus tendon injury - tendon retraction - nonoperative treatment - operative treatment - surgical repair - anchor refixation

Publication History

Article published online:
06 July 2023

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