Begleitpathologien der akuten Verletzung des vorderen Kreuzbands

Due to the complex mechanism of anterior cruciate ligament (ACL) rupture with anterior tibial translation, valgus torque, and internal rotation, concomitant meniscal, ligamentous, and osseous pathologies often occur. Understanding these lesions is essential for diagnostics, surgical management, and prevention of consequent damage. Typical associated pathologies of the meniscus include longitudinal tears, ramp lesions of the medial meniscus, and root lesions of the lateral meniscus. Depending on their severity, these have a large influence on the stability of the knee joint and should therefore be evaluated arthroscopically and treated if necessary. Ligamentous injuries to the medial collateral ligament (MCL) are a frequently described concomitant pathology. Surgical treatment is indicated for Stener-like lesions or persistent valgus instability after 6 weeks of conservative therapy. There is also an increasing focus on chronic peripheral ligament lesions, in particular anteromedial, anterolateral, and posterolateral injuries, which can lead to persistent instability and later failure of the ACL reconstruction if inadequately addressed. In addition to bone bruise of the lateral femoral condyle following valgus trauma and of the posterolateral tibial plateau, common associated osseous injuries are Segond fracture as bony avulsion of the anterolateral complex and posterolateral tibial plateau compression fractures. These posterolateral impressions destabilize the knee joint due to the lack of osseous support of the posterior horn of the lateral meniscus. There is no clear clinical evidence for surgical treatment of these osseous injuries.