Patellaluxation: Diagnostik- und Behandlungsalgorithmus unter Berücksichtigung der Torsion

Zusammenfassung

Hintergrund: Die primäre Patellaluxation und die rezidivierende Patellaluxation sind häufige Krankheitsbilder. Die zugrunde liegende Pathologie bedarf einer differenzierten Diagnostik und Therapie. Mischbilder von pathologischen Veränderungen erschweren die systematische Analyse und Behandlung.
Material und Methodik: Durch die Aufarbeitung der aktuellen Literatur und Überlegungen zum Malalignment kann ein Überblick über die erforderliche Diagnostik gegeben werden. Neben Röntgenaufnahmen gehört das MRT bereits zur essenziellen Diagnostik bei Erstluxation. Bei rezidivierenden Luxationen muss die Diagnostik erheblich erweitert werden, um alle pathologischen Veränderungen zu erfassen. In diesen Fällen gehören das Torsions-CT und Ganzbeinaufnahmen zur grundlegenden Diagnostik.
Ergebnisse: Die verfügbaren Ergebnisse geben Hinweise auf eine erfolgreiche Strategie. Unter Berücksichtigung der genauen Analyse findet die Torsionskorrektur eine neue Bedeutung im patellofemoralen Gelenk. Durch den vorgestellten Diagnostik- und Behandlungsalgorithmus sollen die Entscheidungen vereinfacht werden.
Schlussfolgerung: Der vorgeschlagene Behandlungsalgorithmus kann sich nur z. T. auf evidenzbasierte Daten stützen. Er orientiert sich darüber hinaus an logischen Überlegungen zur Biomechanik im patellofemoralen Gelenk und der Wiederherstellung des physiologischen Alignments.

Abstract

Background: Patella dislocation and re-dislocation are common diseases. Although patella dislocation is frequent, it always poses a challenge concerning diagnostics and therapy. Mixed forms of pathological disorder in the patellofemoral joint make the analysis of the malalignment and the choice of the correct treatment more difficult.
Material and Methods: By reviewing the available literature of the last few years and taking into account considerations concerning the malalignment, an overview of the necessary diagnostics can be given. Radiographs and MRI are essential parts of the diagnostics after a traumatic patella dislocation. After re-dislocation, more extensive diagnostics are required to determine all pathological aspects of the malalignment. In this situation, a CT scan for measuring the torsion of the femur and the tibia as well as the TT-TG distance (tibial tubercle – trochlea groove), and the full weight-bearing long leg standing radiograph are part of the fundamental diagnostics.
Results: The results that are presented in the literature provide some indications for a successful treatment. In consideration of the thorough analysis of the malalignment, the torsional correction of the femur and/or the tibia gains a new importance in the patellofemoral joint. The presented algorithm for diagnostics and treatment should make the decision for the best treatment easier.
Conclusion: The proposed algorithm for diagnostics and treatment is only partially founded on evidence-based results. Moreover, it takes into consideration reflections concerning the biomechanics of the patellofemoral joint and the realignment of this joint.

Schlüsselwörter

patellofemorales Gelenk - Patellaluxation - Torsionskorrektur - Fehlstellung - Osteotomie

Key words

patellofemoral joint - patella dislocation - torsional correction - malalignment - osteotomy

^* Beide Autoren haben zu gleichen Teilen zur Entstehung dieser Arbeit beigetragen.

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