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Operative Versorgung kindlicher Meniskusläsionen

Indikation und Ergebnisse

Surgical treatment of meniscus lesions in children

Indication and results

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die richtige Indikation für die operative Behandlung von Meniskusläsionen bei Kindern zu stellen, ist schwierig, da diese häufig nicht adäquat ihre Symptome beschreiben und die klinische Untersuchung problematisch sein kann. Die meisten Meniskusläsionen bei Kindern sind traumatisch oder stehen im Zusammenhang mit dem Vorliegen eines Scheibenmeniskus. Sie können jedoch auch wie im adulten Knie durch eine chronische Instabilität des Kniegelenks entstehen. Meist ist bei einer chronischen vorderen Kreuzbandinstabilität der mediale Meniskus betroffen.

Die Möglichkeiten der operativen Behandlung sind zum einen die partielle oder die totale Meniskektomie, zum anderen die Meniskusnaht. Dabei gilt das Prinzip, so viel wie möglich des betroffenen Meniskus zu erhalten, um eine mögliche Arthroseentwicklung zu minimieren. Für die partielle Meniskektomie wurden in der Literatur gute Resultate beschrieben. Die Langzeitergebnisse waren jedoch charakterisiert mit frühen degenerativen Gelenkveränderungen. Die Meniskusnaht liefert bei geeigneter Indikation in der überwiegenden Mehrzahl der Fälle zufrieden stellende Resultate, selbst wenn der Riss nicht vollständig geheilt ist. Neuere Ergebnisse zeigten, dass genähte Meniszi bei Kindern auch im mittelfristigen Verlauf in bis zu 80% der Fälle erhalten bleiben können. Der Bandstatus hat einen wichtigen Einfluss auf das Resultat der Meniskusnaht. Von isolierten Meniskusrekonstruktionen ohne begleitende stabilisierende Maßnahme des Bandapparats sollte abgesehen werden, da die Rerupturrate in diesen Fällen zu hoch ist. Andererseits werden besonders hohe Heilungsraten bei Meniskusnähten mit kombinierter vorderer Kreuzbandersatzplastik beschrieben.

Abstract

Finding the correct indication for the surgical treatment of meniscus lesions in children remains demanding as they often do not adequately describe their symptoms and the clinical examination in these patients can be difficult. Most of the meniscus lesions in children are either traumatic or related to the presence of a discoid lateral meniscus. However, as in adults meniscus lesions can also be related to chronic knee laxities. They usually occur on the medial meniscus in the presence of a chronic insufficiency of the anterior cruciate ligament (ACL).

Surgical options are partial meniscectomy, total meniscectomy or meniscus repair with the fundamental principle of preserving the greatest amount of meniscus tissue to minimize subsequent articular cartilage degeneration. Partial meniscectomy has been reported to provide good short-term results. In the long-term, the results are characterized by early degenerative changes. Meniscus repair leads to clinically satisfactory results in the majority of patients even if the tear is not fully healed. In the mid-term and long-term recurrent tear rates of 20–30% have been reported in the literature for adults but larger series presenting rerupture rates in children have not yet been published. Finally, the ACL status has to be considered in the decision-making process on whether a resection or a reconstruction should be done. In chronic ACL deficiency, the percentage of reparable tears decreases. On the other hand, high healing rates have been reported for meniscus repair combined with ACL reconstruction.

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  1. Service de Chirurgie Orthopédique et Traumatologique, Centre d’Orthopédie et de Médecine du Sport , Clinique d’Eich, Centre Hospitalier de Luxembourg , 78, rue d’Eich, L-1210, Luxembourg, Luxemburg

    O. Lorbach, P. Wilmes, D. Pape &  R. Seil

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  1. O. Lorbach
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  2. P. Wilmes
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  3. D. Pape
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  4. R. Seil
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Correspondence to R. Seil.

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Lorbach, O., Wilmes, P., Pape, D. et al. Operative Versorgung kindlicher Meniskusläsionen. Arthroskopie 22, 27–34 (2009). https://doi.org/10.1007/s00142-008-0498-3

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