Zusammenfassung
Akute Patellaluxationen treten bei Kindern und Jugendlichen häufiger als im Erwachsenenalter auf. Eine genaue Analyse des Unfallmechanismus sowie der zugrunde liegenden knöchernen und weichteiligen Risikofaktoren sind die Voraussetzung für eine individuell angepasste Therapieempfehlung. Begleitende (osteo-)chondrale Frakturen stellen eine absolute Operationsindikation dar, während die isolierte Patellaerstluxation bei geringem Risikoprofil für eine Rezidivluxation primär konservativ behandelt werden kann. Eine Empfehlung zur Operation sollte grundsätzlich „a la carte“ ausgesprochen werden, d. h. sich inhaltlich an der zugrunde liegenden Problematik, somit dem individuellen Risikoprofil orientieren. Alle chirurgischen Maßnahmen zur Verbesserung der patellofemoralen Instabilität im Wachstumsalter orientieren sich an einer Integrität der kniegelenknahen Wachstumsfugen.
Abstract
Acute patellar dislocations are more frequent in children and adolescents compared to adults. A clear analysis of trauma mechanism as well as bony and soft tissue risk factors is necessary for an individual treatment approach. Surgery is unavoidable with concomitant (osteo-)chondral lesions, whereas isolated patellar dislocation with low risk for recurrent dislocation can be treated conservatively. If surgery is recommended, an individual approach following the patient’s risk factors should be defined (a la carte surgery). All surgical strategies in adolescents must respect the integrity of the open physis.
Literatur
Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32(5):1114–1121
Jaquith BP, Parikh SN (2017) Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop 37(7):484–490
Vavken P, Wimmer MD, Camathias C, Quidde J, Valderrabano V, Pagenstert G (2013) Treating patella instability in skeletally immature patients. Arthroscopy 29(8):1410–1422
Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 90(3):463–470
Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22(10):2308–2314
Hevesi M, Heidenreich MJ, Camp CL, Hewett TE, Stuart MJ, Dahm DL et al (2019) The recurrent instability of the patella score: a statistically based model for prediction of long-term recurrence risk after first-time dislocation. Arthroscopy 35(2):537–543
Balcarek P, Jung K, Frosch KH, Sturmer KM (2011) Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 39(8):1756–1761
Strecker W (2006) Planning analysis of knee-adjacent deformities. I. Frontal plane deformities. Oper Orthop Traumatol 18(3):259–272
Muhamad AR, Freitas JM, Bomar JD, Dwek J, Hosalkar HS (2012) CT and MRI lower extremity torsional profile studies: measurement reproducibility. J Child Orthop 6(5):391–396
Magnussen RA, Verlage M, Stock E, Zurek L, Flanigan DC, Tompkins M et al (2017) Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surg Sports Traumatol Arthrosc 25(8):2352–2356
Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER (2016) Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(3):760–767
Felus J, Kowalczyk B (2012) Age-related differences in medial patellofemoral ligament injury patterns in traumatic patellar dislocation: case series of 50 surgically treated children and adolescents. Am J Sports Med 40(10):2357–2364
Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39(7):1444–1449
Gurusamy P, Pedowitz JM, Carroll AN, Johnson K, Chambers HG, Edmonds EW et al (2021) Medial patellofemoral ligament reconstruction for adolescents with acute first-time patellar dislocation with an associated loose body. Am J Sports Med 49(8):2159–2164
Schlumberger M, Schuster P, Hofmann S, Mayer P, Immendorfer M, Mayr R et al (2021) Midterm results after isolated medial patellofemoral ligament reconstruction as first-line surgical treatment in skeletally immature patients irrespective of patellar height and trochlear dysplasia. Am J Sports Med 49(14):3859–3866
Nelitz M, Dornacher D, Dreyhaupt J, Reichel H, Lippacher S (2011) The relation of the distal femoral physis and the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 19(12):2067–2071
Uppstrom TJ, Price M, Black S, Gausden E, Haskel J, Green DW (2019) Medial patellofemoral ligament (MPFL) reconstruction technique using an epiphyseal femoral socket with fluoroscopic guidance helps avoid physeal injury in skeletally immature patients. Knee Surg Sports Traumatol Arthrosc 27(11):3536–3542
Lind M, Enderlein D, Nielsen T, Christiansen SE, Fauno P (2016) Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 24(3):666–671
Sillanpaa PJ, Maenpaa HM, Mattila VM, Visuri T, Pihlajamaki H (2009) A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note. Knee Surg Sports Traumatol Arthrosc 17(5):508–512
Milinkovic DD, Fink C, Kittl C, Sillanpaa P, Herbst E, Raschke MJ et al (2021) Anatomic and biomechanical properties of flat medial patellofemoral ligament reconstruction using an adductor magnus tendon graft: a human cadaveric study. Am J Sports Med 49(7):1827–1838
Becher C, Kley K, Lobenhoffer P, Ezechieli M, Smith T, Ostermeier S (2014) Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 22(10):2452–2457
Nelitz M, Dreyhaupt J, Williams SRM (2018) No growth disturbance after trochleoplasty for recurrent patellar dislocation in adolescents with open growth plates. Am J Sports Med 46(13):3209–3216
Camathias C, Studer K, Kiapour A, Rutz E, Vavken P (2016) Trochleoplasty as a solitary treatment for recurrent patellar dislocation results in good clinical outcome in adolescents. Am J Sports Med 44(11):2855–2863
Niu J, Qi Q, Hao K, Lin W, Piao K, Wang F (2020) The morphology of patella changed significantly after soft tissue correction for children with recurrent patella dislocation. BMC Musculoskelet Disord 21(1):833
Fu K, Duan G, Liu C, Niu J, Wang F (2018) Changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children. Bone Joint J 100(6):811–821
Nelitz M (2018) Femoral derotational osteotomies. Curr Rev Musculoskelet Med 11(2):272–279
Grisch D, Dreher T (2019) Torsion and torsional development of the lower extremities. Orthopade 48(6):523–530
Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325
Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104
Thevenin-Lemoine C, Ferrand M, Courvoisier A, Damsin JP, Ducou le Pointe H, Vialle R (2011) Is the Caton-Deschamps index a valuable ratio to investigate patellar height in children? J Bone Joint Surg Am 93(8):e35
Grammont PM, Latune D, Lammaire IP (1985) Treatment of subluxation and dislocation of the patella in the child. Elmslie technic with movable soft tissue pedicle (8 year review). Orthopade 14(4):229–238
Dickens AJ, Morrell NT, Doering A, Tandberg D, Treme G (2014) Tibial tubercle-trochlear groove distance: defining normal in a pediatric population. J Bone Joint Surg Am 96(4):318–324
Marsh JS, Daigneault JP, Sethi P, Polzhofer GK (2006) Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique. J Pediatr Orthop 26(4):461–465
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Jörg Dickschas, Bamberg
Matthias Feucht, Stuttgart
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Schoepp, C. Patellaluxation bei Kindern und Jugendlichen. Knie J. 4, 88–93 (2022). https://doi.org/10.1007/s43205-022-00148-w
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DOI: https://doi.org/10.1007/s43205-022-00148-w