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Die kindliche vordere Kreuzbandruptur

Systematisches Review zu klinischen Ergebnissen und Komplikationen im Vergleich von konservativer und operativer Therapie
  • Amelie StöhrEmail author
  • Theresa Diermeier
  • Alexander Barié
Leitthema
  • 3 Downloads

Zusammenfassung

Hintergrund

Es gibt keine klaren Therapieempfehlungen für Patienten mit offenen Wachstumsfugen und vorderer Kreuzbandruptur (VKB-Ruptur).

Fragestellung

Ziel des vorliegenden systematischen Reviews war es, die operative und konservative Behandlung im Hinblick auf ein objektives klinisches Ergebnis und Komplikationen bei Kindern mit intraligamentären VKB-Rupturen zu vergleichen.

Material und Methoden

Eine umfassende Literaturrecherche wurde aus den Datenbanken Pubmed, Medline und Cochrane durchgeführt. Eingeschlossen wurden Artikel in englischer Sprache im Veröffentlichungszeitraum 1/2000 bis 11/2017 mit einer Nachbeobachtungszeit von mindestens 24 Monaten, mit mindestens 10 eingeschlossenen Patienten pro Studie, Patienten im Alter von 14 Jahren oder jünger, mit offenen Wachstumsfugen oder Tanner-Stadium <III.

Ergebnisse

Die Einschlusskriterien wurden von 20 Artikeln erfüllt. Die Ergebnisse nach VKB-Rekonstruktion stellten 16 Studien (n = 411) und die nach rein konservativer Behandlung 2 Studien (n = 86) dar; 2 Studien verglichen die VKB-Rekonstruktion (n = 22) mit der konservativen Behandlung (n = 32). Insgesamt 41,8 % der Patienten zeigten bereits initial Meniskusrisse und 1,5 % chondrale oder osteochondrale Defekte. Die mittlere Crossover-Rate nach primär konservativer Behandlung betrug 29,6 %. Die operative VKB-Rekonstruktion führte zu signifikant besseren objektiven Ergebnissen, wobei kein Unterschied zwischen den verwendeten Operationstechniken erkennbar war. Im Hinblick auf Komplikationen wie Reruptur und postoperative Wachstumsstörungen konnte kein signifikanter Unterschied zwischen transepiphysären und epiphysenfugenschonenden Techniken festgestellt werden.

Schlussfolgerung

VKB-Rupturen bei Kindern weisen häufig Meniskus- und Knorpelverletzungen auf und sind eine Indikation zur operativen Rekonstruktion. Eine konservative Behandlung ist eine alternative Option, aber die hohe Konversionsrate von bis zu 50 % muss vorher diskutiert werden. Darüber hinaus sind eine anhaltende Instabilität oder wiederkehrende Episoden von „Giving-Way“-Phänomenen relevante Risikofaktoren für Sekundärverletzungen und somit eine Indikation zur operativen Rekonstruktion.

Schlüsselwörter

Vordere Kreuzbandrekonstruktion Epiphyse Kinder IKDC Offene Wachstumsfuge 

Pediatric anterior cruciate ligament ruptures

Systematic review of clinical outcomes and complications comparing conservative and surgical treatment

Abstract

Background

There are no clear therapeutic recommendations for anterior cruciate ligament (ACL) rupture in skeletally immature patients.

Objective

The aim of the present systematic review was to compare operative and conservative treatment with regard to objective clinical outcome and complications in children with mid-substance ACL tears.

Materials and methods

A comprehensive literature search was carried out in the databases PubMed, Medline and Cochrane. Articles in English in the publication period 1/2000 to 11/2017 with a follow-up period of at least 24 months, at least 10 included patients per study, patients 14 years of age or younger, with open physis or Tanner’s stage <III were included.

Results

In all, 20 articles met the inclusion criteria: 16 studies (n = 411) reported results after ACL reconstruction and 2 studies (n = 86) after mere conservative treatment, 2 studies compared ACL reconstruction (n = 22) with conservative treatment (n = 32), 41.8% of patients had meniscal tears and 1.5% chondral or osteochondral defects at diagnosis. The mean crossover rate after primary conservative treatment was 29.6%. ACL reconstruction resulted in significantly better objective outcomes, with no discernible difference between the described surgical techniques. With regard to complications such as rerupture rate and postoperative growth disturbances, no significant difference between transphyseal and physeal sparing techniques could be identified.

Conclusion

ACL ruptures in children are frequently associated with meniscal and cartilage injuries and are an indication for surgical intervention. Conservative treatment is an alternative option, but the high conversion rate of up to 50% needs to be discussed in advance. In addition, persistent instability or recurrent episodes of giving-way phenomena are relevant risk factors for secondary injuries and thus an indication for surgical reconstruction.

Keywords

Anterior cruciate ligament reconstruction Epiphysis Adolescent IKDC Skeletally immature 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Stöhr, T. Diermeier und A. Barié geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH 2019

Authors and Affiliations

  • Amelie Stöhr
    • 1
    Email author
  • Theresa Diermeier
    • 2
  • Alexander Barié
    • 3
  1. 1.OCM-KlinikMünchenDeutschland
  2. 2.Abteilung für SportorthopädieKlinikum rechts der Isar, TU MünchenMünchenDeutschland
  3. 3.Bereich Sportorthopädie und Sporttraumatologie, Zentrum für Orthopädie, Unfallchirurgie und ParaplegiologieUniversitätsklinikum HeidelbergHeidelbergDeutschland

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