Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Neue Qualitäts-Beurteilungs-Richtlinie Arthroskopie

Seit dem 1. Juli 2020 gibt es eine neue Q-Beurteilungs-Richtlinie für alle niedergelassenen Ärzte. Ab sofort müssen aus den vorgelegten Unterlagen die OP-Indikation und das ausgewählte OP-Verfahren nachvollziehbar dokumentiert sein.

Hier finden Sie eine Liste mit möglichen Indikations-Begründungen aller gängigen arthroskopischen Eingriffe an Knie und Schulter. Die Inhalte könne in die jeweilige Praxis-Software eingepflegt werden. Eine Anpassung der Liste auf die individuelle Situation ist unbedingt notwendig. Die Auswahl des Eingriffes sollte so dokumentiert sein, dass sie sich dem fachkundigen Kollegen in der KV-Kommission erschließt. Bei Abweichungen vom medizinischen Standard sollten Erläuterungen zum Verfahren dokumentiert werden.

 

Beispiele

Die Indikation zur arthroskopischen Operation ergibt sich in diesem individuellen Fall aufgrund:

 

von persistierenden Schmerzen
der Erfolglosigkeit der bisherigen Behandlung
des langen Beschwerdezeitraumes
fehlender nicht operativer Behandlungsoptionen mit gleicher Ergebniswahrscheinlichkeit
des Verletzungsmusters
des kombinierten Verletzungsmusters
der subjektiven Instabilität
der objektiven Instabilität
der komplexen Instabilität
der Bewegungseinschränkung
der Blockade(n)
der Gelenkschwellung(en)
der Arbeitsunfähigkeit
der Sportunfähigkeit
des Aktivitätsanspruches
des sportlichen Anspruches
der beruflichen Anforderungen
des hohen Leidensdruckes
des expliziten Patientenwunsches
der Notwendigkeit zu einer weiterführenden intraartikulären Diagnostik (staging OP) bei komplexem Schadensmuster

 

 

spezifische OP-Indikation Schulter

 

Aufgrund der subakromialen Enge droht ohne Operation eine zunehmende Sehnenschädigung.
Aufgrund der Form der Sehnenruptur ist ohne Sehnenrekonstruktion eine Größenprogredienz, ggf. mit klinischer Verschlechterung und ggf. zukünftiger Unmöglichkeit der Rekonstruktion zu erwarten.
Aufgrund des Instabilitätsmusters ist ohne operative Stabilisierung mit einer rezidivierenden Schulterinstabilität und/oder zunehmenden Gewebeschäden zu rechnen.
Trotz Omarthrose ist durch eine arthroskopische Operation eine Verbesserung der Beschwerden zu erwarten

 

 

spezifische OP-Indikation Knie

 

Trotz der isolierten Kreuzbandverletzung ist aufgrund des Alters und des sportlichen und des beruflichen Anspruches eine Kreuzbandplastik indiziert.
Aufgrund der Meniskusrissform droht ohne Operation eine zunehmende Knorpelschädigung.
Es sind die Ausnahmetatbestände des GBA-Beschlusses zur Arthroskopie bei Gonarthrose (Blockaden, freier Gelenkkörper) erfüllt.

 

spezifische OP-Indikation Patientenwunsch

 

Der Pat. wünscht explizit ein arthroskopisches Vorgehen.
Der Pat. wünscht explizit ein operatives Vorgehen unter Verzicht auf (weitere) nicht operative Behandlungen.

Der Pat. wünscht explizit ein minimal-invasives Vorgehen.

Der Pat. wünscht explizit keine Endoprothese.
Der Pat. wünscht explizit keine Umstellungsosteotomie.
Der Pat. wünscht explizit einen Rekonstruktionsversuch.
Der Pat. wünscht explizit keine knöcherne Schulterstabilisation.
Der Pat. wünscht explizit eine nochmalige Operation.

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