Vermeidung des patellofemoralen Overstuffings

 

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Zusammenfassung

Die Rekonstruktion des patellofemoralen Kompartiments und somit die Vermeidung eines Overstuffings ist ein wichtiger Baustein auf dem Weg zu einer erfolgreichen Knie-TEP. Dass dies nicht immer gelingt, zeigt die relativ hohe Revisionsrate von ca. 15 % für das patellofemorale Kompartiment. Das Overstuffing, als ein Problem, kann dabei zahlreiche Ursachen aufweisen und auch zu multiplen klinischen Symptomen führen, die von der limitierten Flexion über ein patellofemorales Maltracking bis hin zum vorderen Knieschmerz reichen können. Aufgrund der Relevanz des patellofemoralen Overstuffings werden im folgenden Artikel die verschiedenen möglichen Fehlerquellen dargestellt. Es werden weiterhin Lösungsmöglichkeiten zur Vermeidung erläutert. Die Ursachen des patellofemoralen Overstuffings sind vielfältig. Die Mehrzahl der Fehler treten femoral auf. Aber auch patellar und gelegentlich tibial existieren Fehlermöglichkeiten, die berücksichtigt werden müssen. Bei der Positionierung der femoralen Resektionsblöcke ist sowohl die distale Resektionsebene (Extension/Flexion) von entscheidender Bedeutung als auch die Größenwahl im AP-Block (Anterior–posterior-Block). Hier sollten über eine präoperative Analyse und Prothesenplanung insbesondere im seitlichen Röntgenbild die optimale Prothesengröße und Position bestimmt werden. Bei der Patella ist die Resektionsebene und -höhe entscheidend, um ein Overstuffing zu vermeiden. Auch die Platzierung der Patellakomponente kann, bei lateraler Position, eine Ursache des Overstuffings sein. Zusammenfassend ist die anatomische Rekonstruktion des patellofemoralen Kompartiments ein wichtiger Teil der Knie-TEP-Implantation. Die Vermeidung des patellofemoralen Overstuffings ist durch eine exakte präoperative Planung der femoralen Komponentengröße und -position sowie durch eine präzise Umsetzung der Planung inklusive suffizienter Resektionen möglich.

Abstract

Reconstruction of the patello-femoral compartment and by that avoidance of an overstuffing is one of the important steps for a successful TKA. A revision rate of around 15 % due to problems of the patello-femoral compartment demonstrates that this is not achieved in all cases. There can be many reasons for an overstuffing and also the symptoms can be very variable, showing sometimes a limited flexion, patello-femoral maltracking or anterior knee pain. Due to its relevance the following paper demonstrates the different reasons for a patello-femoral overstuffing. Further possible solutions for avoidance of overstuffing are described. The reasons for patello-femoral overstuffing are multiple. The majority is caused on the femoral side, however additional patellar and tibial reasons exist. During positioning of the femora resection blocks, the distal resection plane (extension/flexion) as well as the AP block for sizing is crucial. For that a pre-op analysis and implant planning in the lateral view of the X-ray should be performed in order to optimise implant size and position. For the patella the correct resection height and plane are important to avoid an overstuffing. A lateral patella component position can be another reason for an overstuffing. In conclusion, it can be stated that an anatomic reconstruction of the patello-femoral compartment is an important part of TKA surgery. The avoidance of a patello-femoral overstuffing can be achieved by exact pre-op planning of the femoral component size and position, and by precise surgery with sufficient bone resection.

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