{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T22:27:12Z","timestamp":1709936832919},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sportverletz Sportschaden"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Patellofemorale Dysbalance \u00e4u\u00dfert sich meist durch 2 Symptome: vorderer Knieschmerz und patellofemorale Instabilit\u00e4t. Die Ursachen der Dysbalance sind jedoch deutlich vielf\u00e4ltiger. In den letzten Jahren sind zunehmend auch die Achsdeviationen als Ursache der patellofemoralen Dysbalance in den Fokus ger\u00fcckt. Hierbei z\u00e4hlt zun\u00e4chst in der Frontalachse das Valgus-Knie als Risikofaktor. Aber auch Torsionsdeformit\u00e4ten z\u00e4hlen als Achsabweichung. Die erh\u00f6hte femorale Innentorsion sowie die erh\u00f6hte tibiale Aussentorsion sind hier die entscheidende Pathologie. Der Pathomechanismus besteht in einer zunehmenden Lateralisationstendenz der Patella. Dies f\u00fchrt auf Dauer zu Schmerzen, Instabilit\u00e4t und wohl auch patellofemoraler Knorpeldegeneration. Therapie der Wahl ist hier die Osteotomie. Die Varisationsosteotomie bei Valgus-Abweichungen wird je nach Lokalisation der Deformit\u00e4t femoral oder tibial ausgef\u00fchrt. Femoral kann die Osteotomie medial zu- oder lateral aufklappend ausgef\u00fchrt werden, tibial muss die Osteotomie medial schlie\u00dfend ausgef\u00fchrt werden. Die Kombination der Osteotomie mit einer MPFL-Plastik, gegebenenfalls auch erst im Rahmen der Metallentfernung, kann erwogen werden. Die zweite Gruppe der Achskorrekturen mit Relevanz bei patellofemoraler Dysbalance ist die Torsionsosteotomie. Die femorale Osteotomie wird suprakondyl\u00e4r ausgef\u00fchrt, hier wird eine Au\u00dfentorsionskorrektur durchgef\u00fchrt. Tibial wird eine supratuberosit\u00e4re Innentorsionsosteotomie durchgef\u00fchrt, Abweichungen bis zu 15\u00b0 d\u00fcrfen korrigiert werden, h\u00f6here Torsionswerte verbieten sich aufgrund der Gef\u00e4hrdung des Nervus peroneus und der Gefahr des Kompartmentsyndroms. Die Nachbehandlung beinhaltet bei allen Osteotomien eine Teilbelastung von 4\u20136 Wochen, die Metallentfernung kann ab einem halben Jahr nach Osteotmie durchgef\u00fchrt werden. Die Relevanz der Osteotomien im Zusammenhang mit patellofemoraler Dysbalance wird erst in den letzten Jahren in verschiedenen Algorithmen und Reviews vermehrt gesehen. Verschiedene Publikationen berichten \u00fcber sehr gute Ergebnisse nach derartigen Korrektureingriffen. Sowohl die patellofemorale Instabilit\u00e4t kann beseitigt werden als auch eine signifikante Schmerzreduktion kann herbeigef\u00fchrt werden.<\/jats:p>","DOI":"10.1055\/a-1486-1804","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T23:33:06Z","timestamp":1639092786000},"page":"210-217","source":"Crossref","is-referenced-by-count":1,"title":["Relevanz und Versorgung von Beinachsen- und Torsionsabweichungen bei chronischer Patellainstabilit\u00e4t"],"prefix":"10.1055","volume":"35","author":[{"given":"Joerg","family":"Dickschas","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Orthop\u00e4die und Unfallchirurgie, SozialStiftung Bamberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,12,9]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.2106\/JBJS.G.00072","article-title":"Acute patellar dislocation in children and adolescents: a randomized clinical trial","volume":"90","author":"S Palmu","year":"2008","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.arthro.2014.11.040","article-title":"Does Operative Treatment of First-Time Patellar Dislocations Lead to Increased Patellofemoral Stability? 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