Verletzung der Quadrizeps- und Patellarsehne

Zusammenfassung

Strecksehnenrupturen des Kniegelenks sind seltene, aber relevante Verletzungen, die zu einer ausgeprägten Einschränkung der Funktion des Streckapparats und somit der gesamten unteren Extremität führen können. Ursache für diese Rupturen sind i. d. R. degenerative Vorschäden der Quadrizeps- oder Patellarsehne, die im Falle einer maximalen Anspannung der Quadrizepsmuskulatur im Rahmen eines inadäquaten Traumas zu einer Ruptur der Sehne führen können. Die Diagnosestellung ist im Falle einer vollständigen Ruptur meist im Rahmen einer gründlichen klinischen Untersuchung möglich. Bei unklarem klinischem Befund im Falle von Teilrupturen oder Rerupturen sollte eine Sonografie und/oder eine MRT-Diagnostik erfolgen. Die Therapie erfolgt i. d. R. operativ mittels direkter Adaptation der Sehnenenden mit Naht mittels U-, Kessler- oder Bunnell-Nähten. Die Fixation mit den knöchernen Ansatzstellen im Bereich der Patella oder Tuberositas kann entweder mittels transossärer Nähte oder Knochenankern erfolgen. Bei chronischen Rupturen oder Rerupturen ist meist eine Sehnenaugmentation mit autologem Sehnenmaterial notwendig. Die Nachbehandlung sollte unter Schonung der Nähte, jedoch mit frühen passiven Übungen der Beweglichkeit des Kniegelenks erfolgen, um Komplikationen zu verhindern.

Abstract

Extensor tendon ruptures of the knee joint are rare but relevant injuries, which may severely restrict the function of the extensor mechanism and the entire lower extremity. Such ruptures are usually caused by previous degenerative damage to the quadriceps or patellar tendon, which may lead to a tendon rupture in the event of maximum tension of the quadriceps muscle as part of an inadequate trauma. A complete rupture is usually diagnosed during a thorough clinical examination. If clinical findings are ambiguous or in the case of partial ruptures or re-ruptures, an ultrasound and/or an MRI scan should be performed. Treatment usually involves surgery with direct apposition of the tendon ends with U sutures, Kessler or Bunnell sutures. Fixation with the bony insertions in the area of the patella or tibial tuberosity can be performed either by transosseous sutures or bone anchors. Chronic ruptures or re-ruptures usually require tendon augmentation with autologous tendon material. Postoperative rehabilitation should be performed with care to protect the sutures, but should include early passive range of motion exercises of the knee joint in order to prevent complications.

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