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Z Orthop Unfall 2022; 160(04): 463-475
DOI: 10.1055/a-1295-0533
CME-Fortbildung

Behandlung der Patellainstabilität

Alexander Kolb
,
Madeleine Willegger
,
Catharina Chiari
,
Reinhard Windhager
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Die Patellainstabilität ist für die PatientenInnen eine belastende Erkrankung mit einer in der orthopädischen Praxis häufig auftretenden Problemstellung. Die Anomalien des patellofemoralen Gelenks, die die Stabilität des Kniescheibenlaufs beeinträchtigen können, sind vielfältig, sodass für eine erfolgreiche Therapie eine strukturierte Analyse essenziell ist. Dieser Beitrag zeigt den Aufbau einer differenzierten Diagnostik und Therapie sowie Beispiele aus der Praxis.
Kernaussagen

  • Bei rezidivierenden Patellaluxationen ist die Indikation zur chirurgischen Therapie aufgrund der zu erwartenden Ineffektivität konservativer Therapien gegeben.

  • Die Patellainstabilität bedarf aufgrund der ursächlichen komplexen Pathologie einer strukturierten klinischen und radiologischen Analyse.

  • Das mediale patellofemorale Ligament (MPFL) ist der bedeutendste passive Weichteilstabilisator der Kniescheibe.

  • Die Dysplasie der femoralen Trochlea, die relative Position der Trochlearinne zur Tuberositas tibiae sowie Beinachsen- und Torsionsfehler sind bedeutende Faktoren der chronischen Patellainstabilität.

  • Die chirurgische Therapieantwort bei Patellainstabilität muss entsprechend der Analyse differenziert gewählt werden.

  • Als operative Therapieoptionen stehen zur Verfügung:

    • MPFL-Plastik,

    • Trochleaplastik,

    • Tuberositas-tibiae-Transfer,

    • Beinachsenkorrektur,

    • Rotationskorrektur,

    • Kombinationseingriffe.



Publication History

Article published online:
13 April 2021

© 2021. Thieme. All rights reserved.

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