Zusammenfassung
Hintergrund
Das Patellofemoralgelenk (PFG) wird durch verschiedene Faktoren beeinflusst, u. a. von der Stellung der Tuberositas tibiae. Eine Instabilität des PFG erfordert eine individuell auf den Patienten abgestimmte Therapie. Bei der Tuberositas-tibiae-Osteotomie (TTO) handelt es sich um einen Standardeingriff, für den es klare Indikationen gibt.
Methoden
Für die Diagnostik sind zunächst eine gründliche Anamnese sowie eine ausführliche klinische Untersuchung erforderlich. Zur genauen Abklärung kommen verschiedene Bildgebungsverfahren, wie Röntgen, Magnetresonanztomographie (MRT) und Computertomographie (CT), zum Einsatz.
Ergebnisse
Die TTO findet hauptsächlich in der Optimierung des patellofemoralen Alignements Anwendung. In der Instabilitätschirurgie wird sie meist als ergänzender Eingriff durchgeführt. Für die Indikationsstellung ist die Ursache des erhöhten TT-TG-Abstands (Distanz zwischen Tuberositas tibiae und Trochlearinne) ausschlaggebend. Die derzeit publizierten Grenzwerte sind dabei kritisch zu sehen. Eine kombinierte Messung mit alternativen Methoden, wie z. B. dem TT-PCL-Abstand (Distanz zwischen Tuberositas tibiae und hinterem Kreuzband), kann für eine genaue Diagnosestellung hilfreich sein.
Schlussfolgerung
Dieser Artikel gibt einen aktuellen Überblick über die Folgen einer TTO. Anamnese, klinische Untersuchung und Bildgebung werden in Bezug auf die Relevanz für eine TTO diskutiert.
Abstract
Background
The patellofemoral joint (PFJ) is influenced by many different factors, one of which is the position of the tibial tubercle. Instability of the PFJ necessitates an individualized patient-oriented therapy. Tibial tubercle osteotomy (TTO) is a standard intervention for which there are defined indications.
Methods
A thorough patient history and a clinical examination are initially necessary for the diagnostics. A more detailed clarification is achieved using X-ray examination, magnetic resonance imaging (MRI) and computed tomography (CT).
Results
The TTO procedure is mostly used for optimization of the patellofemoral alignment and is primarily used in surgery for instability as a supplementary intervention. The cause of an increased tibial tubercle-trochlear groove (TT-TG) distance is decisive for assessing the indications. The currently published threshold values must be critically considered. A combined measurement with alternative methods, such as the tibial tubercle-posterior cruciate ligament (TT-PCL) distance, can be useful for a precise clarification
Conclusion
This article gives an up to date overview of the consequences of TTO. The preoperative assessment is described. Patient history, clinical examination and imaging are discussed in relation to the relevance of a TTO.
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Gerd Seitlinger und F. Dirisamer geben an, dass kein Interessenkonflikt besteht.
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F. Dirisamer, Linz-Puchenau
A. Schmeling, Berlin
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Seitlinger, G., Dirisamer, F. Tuberositas-tibiae-Osteotomie. Arthroskopie 28, 181–185 (2015). https://doi.org/10.1007/s00142-015-0024-3
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DOI: https://doi.org/10.1007/s00142-015-0024-3