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Operative Therapie der Tibialis-anterior-Sehnenruptur

Surgical treatment of tibialis anterior tendon rupture

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Zusammenfassung

Hintergrund

Die Ruptur der Tibialis-anterior-Sehne (TAS) ist eine seltene Entität, zu der in der Literatur nur kleine Fallserien und wenige Fallberichte dokumentiert sind. Ziel dieser Arbeit ist die Aufarbeitung der über 15 Jahre (1997–2012) dokumentierten Literaturberichte sowie der eigenen Fälle.

Material und Methoden

Retrospektiv wurden die publizierten Kasuistiken von 1997–2012 untersucht, welche sich mit der operativen Therapie der TAS-Ruptur befassen. Es wurden 32 Arbeiten mit insgesamt 44 Fällen und 5 Fälle aus dem eigenen Patientengut eingeschlossen. Ausgewertet wurden patientenspezifische Daten (Alter, Traumamechanismus, Nebenerkrankungen, Zeit zur operativen Versorgung), das angewandte Operationsverfahren, das postoperative Ergebnis und die beschriebenen Komplikationen.

Ergebnisse

In dieser Arbeit wurden 30 Männer und 19 Frauen mit einem Durchschnittsalter (DA) von 58 Jahren operativ versorgt. Es handelte sich um 17 Patienten nach adäquatem Trauma (DA 52) und 32 Patienten ohne oder nach Bagatelltrauma (DA 62). Insgesamt konnte bei 33 % (n = 16) eine primäre Sehnennaht durchgeführt werden. Bei 22 % (n = 11) erfolgte eine knöcherne Refixation, bei 43 % (n = 21) war eine plastische Rekonstruktion notwendig. Bei 69 % (n = 34) zeigte sich eine vollständige Funktionswiederherstellung, 26 % (n = 13) hatten leichte Einschränkungen. Komplikationen traten bei 12 % (n = 6) auf, davon eine Reruptur.

Schlussfolgerung

Die Rekonstruktionen von TAS-Rupturen zeigten gute bis sehr gute Ergebnisse. Ein Zusammenhang zwischen Operationsverfahren und Outcome war nicht nachweisbar. Die Auswahl des Operationsverfahrens hängt vom Rupturmechanismus, Lokalisation und Ausmaß der Ruptur, Sehnenbeschaffenheit und Alter der Ruptur und von den Kenntnissen des Operateurs ab.

Abstract

Introduction

Tibialis anterior tendon rupture is rare, with only a few cases and small series having been reported in the literature. In this article, cases reported in the literature from 1997–2012 are reviewed and patients treated by the author are presented.

Materials

Cases published from 1997–2012 needing surgical treatment for tibialis anterior tendon rupture were retrospectively reviewed. In all, 32 articles with a total of 44 reported cases and 5 patients from our own practice were included. Patient-specific data (e.g., age, trauma, secondary diagnosis, and time to surgery), surgical technique, operative result, and documented complications were also evaluated.

Results

The mean age (MA) of the patients (30 men and 19 women) undergoing treatment was 58 years. A total of 17 patients presented as a result of adequate trauma (MA 52) and 32 patients without or minor trauma (MA 62). In 16 patients (33 %), a primary tendon suture was selected, while in 11 patients (22 %) osseous refixation techniques were performed. In 21 patients (43 %), plastic reconstruction was necessary. Total recovery was observed in 69 % of patients (n = 34); 26 % (n = 13) had moderate limitations. Complications were reported in 12 % of cases (n = 6), thereof one re-rupture.

Conclusion

Good to excellent results were observed in tibialis anterior tendon ruptures reconstruction. No associations between surgical treatment and outcome were observed. The selection of the surgical technique depended on rupture mechanism, location, size, tendon constitution, rupture age, and surgeon's experience.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Unfallchirurgie, und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    D. Zajonz, L. Köhler & C.-E. Heyde

  2. Klinik für Chirurgie, Abteilung für orthopädische Chirurgie, Helios Klinikum Schkeuditz, Schkeuditz, Deutschland

    M. Pretzsch

  3. Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    T. Lingscheidt

  4. Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Moche

  5. Orthopädische Abteilung, Collm Klinik Oschatz GmbH, Parkstr.1, 04758, Oschatz, Deutschland

    Roger Scholz

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  1. D. Zajonz
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  2. L. Köhler
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  3. M. Pretzsch
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  4. T. Lingscheidt
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Correspondence to Roger Scholz.

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Interessenkonflikt

D. Zajonz, L. Köhler, M. Pretzsch, T. Lingscheidt, M. Moche, C.-E. Heyde und R. Scholz geben an, dass kein Interessenkonflikt besteht.

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Die Autoren D. Zajonz und L. Köhler haben zu gleichen Teilen zu der Arbeit beigetragen.

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Zajonz, D., Köhler, L., Pretzsch, M. et al. Operative Therapie der Tibialis-anterior-Sehnenruptur. Orthopäde 44, 303–313 (2015). https://doi.org/10.1007/s00132-015-3090-3

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