Druckentlastung (Unloading) im Kniegelenk in Kombination mit knorpelchirurgischen Eingriffen

Zusammenfassung

Bei fokalen Knorpelschäden des Kniegelenks spielt neben einem knorpelchirurgischen Vorgehen die Entlastung des betroffenen Gelenkbereichs eine entscheidende Rolle. Die Entlastung eines geschädigten Gelenkbereichs kann durch Körpergewichtsreduktion, varisierende oder valgisierende Orthesen, durch operative Eingriffe wie arthroskopische Kompartmentententlastung durch Bandstichelung des Ligamentum obliquium posterior oder durch Umstellungsosteotomien erreicht werden. Das knorpelchirurgische und das entlastende Verfahren sollten individuell auf die vorliegende Pathologie und den einzelnen Patienten abgestimmt sein. Die Druckentlastung im Kniegelenk kann langfristig nur durch operative Verfahren erfolgen. Schuhranderhöhungen bzw. Einlagen erreichen nur eine begrenzte Entlastung. Kniegelenksorthesen können dieses Ziel erreichen, haben bei gewünschtem Effekt jedoch eine geringe Patientenakzeptanz.

Abstract

Restoration of a neutral biomechanical environment and reduction of overload is an important factor contributing to the success of any cartilage repair procedure. Reduction of overload can by achieved by so called unloading procedures in order to reduce intraarticular pressure from the repair zone. Unloading can be achieved via loss of weight, wedged shoe insoles, knee braces or via operations such as osteotomies around the knee joint. The cartilage therapy and the concomitant unloading procedure should be adapted to the individual pathology and realistic aims of the patient. Wedged insoles and braces are the least invasive treatment methods. In comparison, however, beneficial effects of braces outline those of laterally wedged heels. Nevertheless long-term compliance with insoles and braces is poor. Concerning braces either because the positive effects of the braces are too small or because the adverse effects are too large. Unloading in the long run may only be achieved through operative procedures. When an osteotomy seems to be too invasive the arthroscopic release of the posterior oblique ligament might be an option. Patients with an intact contralateral chondral status, medium to slight malalignment who want to remain at high activity levels, remain good candidates for unloading osteotomies.

Schlüsselwörter

Entlastung - Kniegelenksorthese - Umstellungsosteotomie - HTO - Knorpelschaden

Key words

unloading - knee brace - unloading osteotomy - high tibial osteotomy - cartilage lesion

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