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Bildgebungsstrategie bei Kniegelenkverletzungen

Imaging strategies for knee injuries

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Zusammenfassung

Verletzungen des Kniegelenks sind häufig. Die Ottawa Knee Rule bietet eine Entscheidungshilfe dahingehend, ob Röntgenaufnahmen indiziert sind. Mittels Sonographie können Verletzungen des Streckapparats und vorderen Kreuzbandes erkannt werden. Ebenso gelingt der Nachweis eines Lipohämarthros als indirektes Zeichen einer intraartikulären Fraktur. Bei komplexen Frakturen, z. B. Tibiaplateaufrakturen, ist eine weiterführende Diagnostik mittels Multislice-CT zur Klassifizierung und präoperativen Planung notwendig. Die Multislice-CT mit gleichzeitiger CT-Angiographie ermöglicht die Anfertigung dreidimensionaler Rekonstruktionen und die nichtinvasive Gefäßdarstellung. Die Magnetresonanztomographie (MRT) ist der Goldstandard zum Nachweis okkulter Frakturen und Verletzungen an Bändern und Menisken. Bei höheren Feldstärken verbessert sich die Diagnostik von Knorpelläsionen. Die virtuelle MR-Arthrographie ist insbesondere nach Meniskusoperation und bei Knorpelläsionen der konventionellen MRT überlegen.

Abstract

Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery.

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Authors and Affiliations

  1. Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt-Universität Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Deutschland

    K. Hegenscheid, R. Puls & C. Rosenberg

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  1. K. Hegenscheid
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  2. R. Puls
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  3. C. Rosenberg
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Correspondence to K. Hegenscheid.

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Dieser aktualisierte und überarbeitete Beitrag erschien ursprünglich in der Zeitschrift „Trauma und Berufskrankheit“ 11/2009.

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Hegenscheid, K., Puls, R. & Rosenberg, C. Bildgebungsstrategie bei Kniegelenkverletzungen. Radiologe 52, 980–986 (2012). https://doi.org/10.1007/s00117-012-2411-3

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  • DOI: https://doi.org/10.1007/s00117-012-2411-3

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