VKB-Verletzungen im Kindes- und Jugendalter

Zusammenfassung

Kinder mit offenen Wachstumsfugen können nicht wie „kleine Erwachsene“ betrachtet oder behandelt werden. Das Verständnis des kindlichen Kniegelenkes und der anatomischen, hormonellen und neuromuskulären Veränderungen im Rahmen des Wachstums bzw. der Entwicklung ist einer der Schlüsselfaktoren für die Diagnose, die Wahl der Therapie und die Nachsorge bei skelettunreifen Patienten mit einer Verletzung des vorderen Kreuzbandes (VKB). Die zügige und korrekte Diagnose und Behandlung dieser VKB-Verletzungen sind entscheidend für den Schutz der langfristigen Integrität des kindlichen Kniegelenks, wobei der Behandlungsverlauf regelmäßig neu bewertet werden muss, um die Therapie individuell auf jeden einzelnen Patienten abzustimmen. Im Falle einer operativen Versorgung muss die Operationstechnik an die offenen Wachstumsfugen angepasst werden. Bei Adoleszenten und Jugendlichen nach Fugenverschluss ist die Sachlage derart verändert, dass im Falle einer operativen Versorgung die OP-Technik zwar identisch zu erwachsenen Patienten sein kann, bei dieser Alterskategorie aber mit einer extrem hohen Rate an Zweitverletzungen (bis zu 30 % ipsilaterale Re-Rupturen oder kontralaterale Erstrupturen) zu rechnen ist. Ziel des vorliegenden Beitrags ist es den aktuellen Kenntnisstand zu kindlichen und jugendlichen VKB-Verletzungen mit ihren Herausforderungen in der Diagnosestellung und der Behandlung darzustellen, wobei ein besonderes Augenmerk auch auf Begleitverletzungen gelegt wird.

Abstract

Children with open growth plates should not simply be regarded or managed as “small adults”. A thorough understanding of the paediatric knee and its growth, along with the anatomical, hormonal, and neuromuscular changes occurring in children during maturation, is one of the key factors in the diagnosis, decision-making, and monitoring of skeletally immature patients with anterior cruciate ligament (ACL) injuries. Timely and accurate diagnosis and treatment of these ACL injuries are crucial to protecting the long-term integrity of the child’s knee with regular reassessments being required to provide each individual patient with the best possible care. In the case of surgical treatment, the surgical technique must be adapted to the open growth plates. Once the growth plates have closed in adolescents and teenagers, surgery can be performed using adult techniques. However, in this age group, an extremely high rate of recurrent injury must be expected (up to 30% ipsilateral re-ruptures or contralateral primary ruptures). The aim of this article is to present the current understanding of paediatric and adolescent ACL injuries, including challenges in their diagnosis and treatment with a particular focus on associated injuries.

Schlüsselwörter

Vorderes Kreuzband - kindlich - skelettunreif - Meniskus - Knorpel

Keywords

Anterior cruciate ligament - paediatric - skeletally immature - meniscus - cartilage

Publikationsverlauf

Eingereicht: 16. Oktober 2024

Angenommen nach Revision: 28. Mai 2025

Artikel online veröffentlicht:
22. Oktober 2025

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