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DOI: 10.1055/a-1486-1654
Der Tuberositas-Transfer im kindlichen Alter
Tibial tubercle osteotomy in children and adolescents![](https://www.thieme-connect.de/media/sport/202104/lookinside/thumbnails/sport-14861654_10-1055-a-1486-1654-1.jpg)
Zusammenfassung
Die patellofemorale Instabilität (PFI) ist eine typische Erkrankung im Kindes- und Jugendalter. Aufgrund des hohen Reluxationsrisikos ist eine gezielte Risikoanalyse notwendig. Die Patella alta und eine veränderte Zugrichtung des Streckapparates, die über den TTTG-Abstand ermittelt werden kann, stellen auch im jungen Alter Hauptrisikofaktoren der PFI dar. Die zunehmend evidenzbasierte Indikationsstellung unterscheidet sich nicht wesentlich von der Erwachsener. Aufgrund der Gefahr einer gestörten Wachstumslenkung kann bei offenen Fugen ein Tuberositas-Transfer jedoch nicht erfolgen, sodass die operativen Techniken den Gegebenheiten angepasst werden müssen. Eine Korrektur der Patella alta und eines erhöhten TTTG-Abstands ist mit weichteiligen distalen Eingriffen ohne Beeinträchtigung der Wachstumsfugen auch im Kindes- und Jugendalter möglich und verbessert die Ergebnisse gegenüber isolierten MPFL-Rekonstruktionen bei Überschreiten von Grenzwerten der Risikofaktoren und korrekter Indikationsstellung.
Abstract
Patellofemoral instability (PFI) is one of the most common knee pathologies in children and adolescents. The high risk of re-dislocation necessitates a targeted risk analysis. A high-riding patella and a changed pulling direction of the extensor apparatus, which can be determined from the TTTG distance, are the main risk factors of PFI, also in a young population. The indication for surgical treatment, which is increasingly based on evidence, does not differ significantly from that of adults. However, due to the risk of disturbance of the growth plates, tibial tubercle osteotomy cannot be performed with open physis, which means that the surgical techniques must be adapted to the circumstances. A correction of a high-riding patella and an increased TTTG distance is possible with distal soft tissue procedures without impairing the growth plates, even in children and adolescents, and leads to better results compared with isolated MPFL reconstructions if the cut-off values of risk factors are exceeded and the indication is correct.
Publikationsverlauf
Artikel online veröffentlicht:
09. Dezember 2021
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