Zusammenfassung
In der vorliegenden Arbeit soll die Frage geklärt werden, ob bei akuten oder rezidivierenden Kniescheibenluxationen die modifizierte minimalinvasive Operation nach Madigan und Insall eine geeignete Operationstechnik ist. In der Zeit vom 1. 1. 2002 bis zum 30. 6. 2005 wurden insgesamt 56 Patienten mit akuten und chronischen Kniescheibenluxationen operiert. Die Patienten wurden nach 8 bis 19 Monaten postoperativ nachuntersucht und subjektive Zufriedenheit (nach Larsen und Lauridsen) abgefragt. 34 der operierten Patienten (94 %) kamen zur Nachuntersuchung. Von diesen zeigten 28 gute, 3 befriedigende und 3 schlechte subjektive Ergebnisse. Kein Patient hatte eine Reluxation. Für die Behandlung akuter und rezidivierender Kniescheibenluxationen ist eine Vielzahl unterschiedlicher operativer Techniken etabliert. Wir sehen entscheidende Vorteile für die von uns bevorzugte minimalinvasive Operationstechnik, bei der die Kniescheibe aktiv über den Musculus vastus medialis stabilisiert wird.
Abstract
The aim of this study is to answer the question whether a modified, minimally invasive Madigan/Insall operation is an appropriate treatment for acute or recurrent patellar dislocations. Between January 1, 2002 and June 30, 2005 a total of 56 patients with acute and chronic patellar dislocations were operated. The patients underwent follow-up examinations between 8 and 19 months postoperatively. Their subjective satisfaction with the result was assessed (according to Larsen and Lauridsen). 34 of the operated patients (94 %) were available for follow-up. 28 of them had a good, 3 a satisfactory and 3 a poor subjective result. No re-dislocation occurred. A large number of operative techniques has been described for the treatment of acute and recurrent patellar dislocation. In our opinion, a minimally invasive operative technique, in which the patella is actively stabilized by the vastus medialis muscle, has decisive advantages compared to conventional techniques.
Literatur
-
1
Abraham E, Washington E, Huan T L.
Insall proximal realignment for disorders of the patella.
Clin Orthop.
1994;
248
61-65
-
2
Aglieti P, Buzzi R D, Diase P, Hieron F.
Surgical treatment of recurrent dislocation of the patella.
Clin Orthop.
1994;
308
8-17
-
3
Arendt E A, Fithian D C, Cohen E.
Current concepts of lateral patella dislocation.
Clin Sports Med.
2002;
21
499-519
-
4
Barbari S, Raukstadt T S, Lichtenberg N, Revem D.
The Hauser operation for patellar dislocation.
Acta Orthop Scand.
1990;
61
32-35
-
5
Bauer F C, Fredmark T, Isberg B.
Krogius tenoplasty for recurrent dislocation of the patella. Failure associated with joint laxity.
Acta Orthop Scand.
1984;
55
267-269
-
6
Chrisman O D, Snook G H, Wilson T C.
A long-term prospective study of the Hauser und Roux-Goldtwaith procedures for recurrent patellar dislocation.
Clin Orthop.
1979;
144
27-30
-
7
Dundy D J, Griffith S D.
Lateral release for recurrent dislocation of the patella.
J Bone Joint Surg.
1989;
71
121-125
-
8
Fithian D C, Paxton E W, Stone M L, Silva P, Davis D K, Elias D A, White L M.
Epidemiology and natural history of acute patellar dislocation.
Am J Sports Med.
2004;
32
1114-1121
-
9
Fithian D C, Paxton E W, Cohen A B.
Indications in the treatment of patellar instability.
J Knee Surg.
2004;
17
47-56
-
10
Fuchs S, Friedrich M.
Beeinflussungsmöglichkeiten von Kniegelenkscores.
Unfallchirurg.
2000;
103
44-50
-
11
Fukushima K, Horaguchi T, Okano T. et al .
Patellar dislocation: arthroscopic patellar stabilization with anchor sutures.
Arthroscopy.
2004;
20
761-764
-
12
Goldthwait J E.
Slipping or recurrent dislocation of the patella: with the report of eleven cases.
Boston Med Surg J.
1904;
150
169-174
-
13
Günther K, Thielemann F, Bottesi M.
Der vordere Knieschmerz bei Kindern und Jugendlichen. Diagnostik und konservative Behandlung.
Orthopäde.
2003;
32
110-118
-
14
Halbrecht J L.
Arthroscopic patella realignment: An all-inside technique.
Arthroscopy.
2001;
17
940-945
-
15
Hauser E DW.
Total transplant for slipping patella.
Surg Gynecol Obstet.
1938;
66
199-214
-
16
Insall J N, Salvati E.
Patella position in the normal knee joint.
Radiology.
1971;
101
101
-
17
Insall J N.
Patella pain syndromes and chondromalacia patellae.
Instr Course Lect.
1981;
30
342-356
-
18
Insall J, Bullough P G, Burstein A H.
Proximal “tube” realignment of the patella for chondromalacia patellae.
Clin Orthop.
1979;
144
63-69
-
19
Juliusson R, Markhede G.
Modified Hauser procedure for recurrent dislocation of the patella. A long-term follow-up study with special reference to osteoarthritis.
Arch Orthop Trauma Surg.
1984;
103
42-46
-
20
Larsen E, Lauridsen F.
Conservative treatment of patellar dislocations: influence of evident factors on the tendency to redislocation and the therapeutic result.
Clin Orthop.
1982;
171
131-136
-
21
Ludolf E.
Patellaluxation. Anlage - habituelle Luxation - Begutachtung - Begutachtung für die gesetzliche Unfallversicherung.
Trauma Berufskrankheit.
2002;
4
206-210
-
22
Madigan R, Wissinger H A, Donaldson W F.
Preliminary experience with a method of quadricepsplasty in recurrent subluxation of the patella.
J Bone Joint Surg [Am].
1975;
57
600-607
-
23
Mencke W, Schneider T, Schullin P, Miechels I, Muller E H.
Habituelle Patellaluxation und Operation nach Goldthwait.
Akt Traumatol.
1991;
21
261-264
-
24
Nam E K, Karzel R P.
Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation: a medium-term follow-up.
Am J Sports Med.
2005;
33
220-230
-
25
Nomura E, Inoue M.
Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation.
Arthroscopy.
2003;
19
E47
-
26
Olk A, Hennig F.
Anatomische Voraussetzungen der Patellaluxation.
Trauma Berufskrankheit.
2002;
4
201-205
-
27
Roux D.
Luxation habituelle de la rotule; traitement operatoire.
Rev Chir Paris.
1888;
8
682-689
-
28
Schäfer N, Lehmann M, Müller W.
Laterale Erstluxation der Patella. Arthroskopische vs. offene Retinaculumnaht.
Arthroskopie.
1993;
6
256-259
-
29
Satterfield W H, Johnson D L.
Arthroscopic patellar “bankart” repair after acute dislocation.
Arthroscopy.
2005;
21
627
-
30
Tallay A, Kynsburg A, Toth S, Szendi P, Pavlik A, Balogh E, Halasi T, Berkes I.
The prevalence of the patellofemoral pain syndrome. Evaluation of the role of biomechanical malalignments and the role of sporting activity.
Orv Hetil.
2004;
145
2093-20101
-
31
Trillat A, Dejour H, Couette A.
Diagnostique et traitement de subluxations recidivantes de la rotule.
Rev Chir Orthop.
1964;
50
813-824
-
32
Viernstein K, Weigert M.
Chondromalacia patellae beim Leistungssportler.
Z Orthop.
1968;
104
422-435
-
33
Wiberg G.
Roentgenographic and anatomic study on the patellofemoral joint.
Acta Orthop Scand.
1941;
12
319-410
Dr. med. Andreas Appelt
Sektion Unfall- und Wiederherstellungschirurgie
Chirurgische Universitätsklinik Heidelberg
Im Neuenheimer Feld 110
69120 Heidelberg
eMail: andreas.appelt@med.uni-heidelberg.de
