Beckennahe Sehnenverletzungen

Zusammenfassung

Avulsionsverletzungen der ischiokruralen Muskulatur (Hamstring) am Tuber ischiadicum oder des M. rectus femoris sind im Gegensatz zu Verletzungen in deren muskulotendinösem Übergang seltene Verletzungen. Sie treten typischerweise bei Sportarten (Fußball, Wasserski) oder beim Ausrutschen mit forcierter Hüftflexion und Knieextension auf. Komplette akute (innerhalb 4 Wochen diagnostiziert) Rupturen der proximalen Hamstring-Sehnen, symptomatische Partialrupturen oder chronische Rupturen mit persistierenden Beschwerden werden mittels Fadenanker über eine dorsale Längsinzision operativ versorgt. Die Magnetresonanztomografie (MRT) ist die Standarduntersuchung zur Beurteilung der Hamstring- oder Sehnenverletzungen des M. rectus femoris. Funktionell zeigen sich nach operativer Refixation subjektiv meist sehr gute Ergebnisse mit in 55–100 % Rückgewinn der präoperativen sportlichen Aktivität. Proximale Sehnenverletzungen des M. rectus femoris werden ebenfalls operiert, damit Athleten möglichst frühzeitig die sportlichen Aktivitäten aufnehmen können. Avulsionsverletzungen der Spina iliaca anterior superior treten v. a. bei Adoleszenten (Sprinter, Langstreckenläufer, Fußballer) auf und sollten bei deutlicher Dislokation eines größeren Fragments und bei hoher sportlicher Aktivität auch operativ versorgt werden.

Abstract

Proximal hamstring avulsions or such of the rectus femoris tendon are rare injuries compared with injuries of their musculotendinous junction. They can be observed typically during sports participation (soccer, waterski) or slip accidents with forced hip hyperflexion and knee extension. Complete acute (diagnosed within 4 weeks after accident) ruptures of the proximal hamstring or symptomatic partial or chronic ruptures should be treated operatively with suture anchors through a posterior longitudinal incision to achieve good functional outcome. MR imaging is the diagnostic standard for the evaluation of hamstring or rectus femoris tendon injuries. Surgical repair of proximal hamstring avulsions leads to a subjective highly satisfying outcome with return to sports activity level rate of 55 to 100 %. For an early return to sports proximal avulsions of the rectus femoris tendon are also treated operatively. Anterior superior iliac spine avulsions are mostly seen in adolescent sprinters, distance runners and soccer players and are operated in cases with greater fragment dislocation.

• Literatur

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