Zusammenfassung
Abrissverletzungen am Sehnen-Knochen-Übergang (Avulsionen) des Adductor longus sind selten. Noch seltener kommen Avulsion an der Iliopsoassehne am Trochanter minor vor. Avulsionsverletzungen der Adduktorenursprünge treten überwiegend bei aktiven Sportlern auf. Avulsionen der Iliopsoassehne sind vorwiegend bei Nichtsportlern, im höheren Alter und häufig ohne auslösendes Ereignis zu verzeichnen. Bei einer Iliopsoasavulsion muss eine möglicherweise zugrunde liegende Pathologie (z. B. Tumor oder Metastase im Trochanter minor) ausgeschlossen werden. In der Literatur sind keine allgemeingültigen Empfehlungen zur Behandlung dieser Verletzungen zu finden, weil nur wenige retrospektive anekdotische Fallbeschreibungen und Fallserien publiziert sind. Deshalb ist noch weitgehend unklar, ob und wann eine konservative oder operative Therapie indiziert ist.
Im Rahmen einer Literaturanalyse (PubMed/Medline) wurden 86 und 155 Arbeiten für Iliopsoas- bzw. Sehnenavulsionen des Adductor longus gefunden. Danach können sowohl Avulsionen des Iliopsoas als auch des Adductor longus grundsätzlich konservativ behandelt werden. Lediglich bei Nichtansprechen auf konservative Therapie, wenn die Adduktorenursprünge oder die Trochanter-minor-Apophyse nach Avulsion eine Dehiszenz von mehr als 2 cm aufweisen, wird gelegentlich eine operative Therapie empfohlen. Für die Sehnenavulsionen des Adductor longus werden Reinsertionen grundsätzlich über verschiedene Knochenanker durchgeführt, während ausgedehnte Avulsionsverletzungen der Trochanter-minor-Apophyse mit Resektion oder Refixation über kanülierte Schraubensysteme verankert werden. Das postoperative Ergebnis wird in den meisten Fällen als gut und sehr gut (exzellent) beschrieben. Wesentliche Komplikationen wurden in beiden Gruppen nicht berichtet.
Abstract
Avulsion injuries of the tendon-bone junction of the adductor longus are rare. Avulsions of the iliopsoas tendon insertion on the lesser trochanter are even rarer. Avulsion injuries of the adductor insertion occur predominantly in active athletes. Iliopsoas tendon avulsions are described mainly in nonathletes, in old age and frequently with no triggering event. In these cases possible underlying pathologies (e.g. tumor or metastases in the lesser trochanter) must be ruled out. In the literature no generally accepted recommendations for treatment of these injuries can be found because only a few retrospective anecdotal case reports and case studies have been published. For this reason, it is mostly unclear if and when a conservative or operative approach is indicated.
A PubMed/Medline literature search resulted in 86 articles for iliopsoas avulsions and 155 hits for adductor tendon avulsions. Accordingly, both injuries can basically be treated conservatively. A surgical treatment is recommended only occasionally when conservative treatment fails and when the adductor insertion or the apophysis of the lesser trochanter is dislocated more than 2 cm after avulsion. Reinsertion for adductor longus tendon avulsion injuries is usually performed by open repair using various anchor systems, while extensive avulsion injuries or non-unions of the apophysis of the lesser trochanter are treated by refixation by cannulated screw systems or resection and anchor refixation of the tendon. The postoperative outcome in most cases is described as good or very good (excellent). No major complications were reported in both groups.
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Lohrer, H. Avulsionsverletzungen der Adduktoren und des Iliopsoas. Unfallchirurg 124, 550–559 (2021). https://doi.org/10.1007/s00113-021-01019-1
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DOI: https://doi.org/10.1007/s00113-021-01019-1