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Rofo 2021; 193(09): 1019-1033
DOI: 10.1055/a-1348-2122
Review

Bildgebende Diagnostik der patellofemoralen Instabilität

Article in several languages: English | deutsch
Kai-Jonathan Maas
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Malte Lennart Warncke
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Miriam Leiderer
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Matthias Krause
2   Department Trauma Surgery and Orthopedics, UKE, Hamburg, Germany
,
Tobias Dust
2   Department Trauma Surgery and Orthopedics, UKE, Hamburg, Germany
,
Jannik Frings
2   Department Trauma Surgery and Orthopedics, UKE, Hamburg, Germany
,
Karl-Heinz Frosch
2   Department Trauma Surgery and Orthopedics, UKE, Hamburg, Germany
,
Gerhard Adam
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Frank Oliver Gerhard Henes
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Zusammenfassung

Hintergrund Die patellofemorale Instabilität (PI) umschreibt ein erhöhtes Luxations- bzw. Reluxationsrisiko der Kniescheibe im Patellofemoralgelenk (PFG). In den meisten Fällen liegt ein adäquates Trauma mit Patellaluxation und Verletzung des Haltebandapparats oder das Vorliegen anatomischer Risikofaktoren vor, welche zu einem unphysiologischen Bewegungsablauf im Patellofemoralgelenk führen (Maltracking). Neben der Anamnese und der klinischen Untersuchung stellt die radiologische Bildgebung (Röntgen, Computertomografie und Magnetresonanztomografie) den zentralen Grundpfeiler bei der Diagnostik der PI dar, um das Vorliegen und den Ausprägungsgrad anatomischer Risikofaktoren zu evaluieren.

Methodik Im Rahmen dieser Übersichtsarbeit wird der aktuelle Stellenwert der bildgebenden Diagnostik und Therapieplanung der patellofemoralen Instabilität vorgestellt. Das Ziel dieser Arbeit besteht in der übersichtlichen Darstellung der wichtigsten anatomischen Risikofaktoren der PI sowie der Möglichkeiten der Bildgebung, diese zu detektieren und zu quantifizieren.

Ergebnisse und Schlussfolgerung Die PI basiert häufig auf einer multifaktoriellen Disposition. Bei den Risikofaktoren muss zwischen der Trochleadysplasie, strukturellen Defekten des medialen patellofemoralen Ligaments (MPFL), der Patella alta, einer erhöhten Tuberositas-Tibiae-Trochlea-Groove-Distanz (TT-TG), Torsionsdeformitäten sowie dem Genu valgum differenziert werden. Obwohl das konventionelle Röntgen häufig noch zur Basisdiagnostik der PI eingesetzt wird, ist die Schnittbilddiagnostik (MRT und CT) heutzutage die Methode der Wahl, um die PI und ihre zugrunde liegenden Risikofaktoren zu evaluieren.

Kernaussagen: 

  • Die PI wird durch ein erhöhtes Luxations- bzw. Reluxationsrisiko der Patella im PFG charakterisiert.

  • Als wichtigste anatomische Risikofaktoren der PI gelten die Trochleadysplasie, ein erhöhter TT-TG-Abstand, die Patella alta sowie Torsionsdeformitäten und das Genu valgum.

  • Mithilfe der CT und MRT gelingen eine präzise Diagnostik der PI sowie eine genaue Charakterisierung und Quantifizierung der zugrunde liegenden Risikofaktoren.

  • Mit der Möglichkeit einer exakten Evaluation aller, häufig in Wechselwirkung miteinander stehenden Risikofaktoren nimmt die Schnittbildgebung bei der individuellen Therapieplanung eine zentrale Rolle ein.

Zitierweise

  • Maas KJ, Warncke ML, Leiderer M et al. Diagnostic Imaging of Patellofemoral Instability. Fortschr Röntgenstr 2021; 193: 1019 – 1033

Key words

patellofemoral joint - knee - patella - patellofemoral instability - maltracking - MRI


Publication History

Received: 15 September 2020

Accepted: 02 December 2020

Article published online:
27 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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