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Z Orthop Unfall 2016; 154(04): 340-351
DOI: 10.1055/s-0042-101560
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Bone Marrow Lesion – Risikofaktoren und pathophysiologische Bedeutung: systematisches Review

Bone Marrow Lesion – Risk-Factors and Pathophysiological Relevance: Systematic Review
G. Spahn
1   Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach
2   Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena
,
M. Biehl
1   Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach
,
G. O. Hofmann
2   Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena
3   Klinik für Unfall- und Wiederherstellungschirurgie, BG Kliniken Bergmannstrost, Halle
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Publikationsverlauf

Publikationsdatum:
12. Februar 2016 (online)

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Zusammenfassung

Zielsetzung: Ziel dieser systematischen Literaturrecherche mit anschließender Metaanalyse war es, mit der idiopathischen Bone Marrow Lesion (BML) assoziierte Faktoren bzw. Risikofaktoren, den Einfluss des Vorhandenseins von BML auf Kniesymptome und den Einfluss auf die Arthroseprogression zu untersuchen. Material und Methode: Zum Stichtag 31.12.2013 erfolgte in den Literaturdatenbanken PubMed, EMBASE, Web of Science und Cochrane ein systematisches Literaturreview unter den Suchbegriffen [[bone marrow lesion] AND [knee]] sowie [[bone marrow edema] AND [knee]]. Über den Zeitraum der Auswertung erfolgten in PubMed regelmäßige Updates bis zum 31.10.2015. Ergebnisse: Von bei der Primärrecherche gefundenen 1331 Studien wurden schließlich 30 in die finale Auswertung einbezogen. Die durchschnittliche Häufigkeit von BML in allen Studien betrug 37,2 %. Die Häufigkeit der gefundenen BML hing signifikant von der verwendeten MRT-Technik (1,0–3,0 T) ab Die Inzidenz für das Auftreten von BML betrug durchschnittlich 3,2 (95 %-KI 1,7–6,3)/1000 Personenmonate. Schwache Assoziationsfaktoren waren weibliches Geschlecht (OR = 1,3 [95 %-KI 1,1–1,7]; p = 0,009), höheres Lebensalter (OR = 1,05 [95 %-KI 0,9–1,3]; p = 0,127) bzw. Übergewicht/Adipositas (OR = 1,1 [95 %-KI 1,1–1,2]; p < 0,001). Knorpelschäden sind signifikant mit der Ausbildung von BML assoziiert (p < 0,001). Die OR beträgt dabei 5,5 (95 %-KI 1,3–22,5). Das Vorhandensein von BML ist mit einer höheren Prävalenz von Knieschmerzen verbunden (OR = 3,2 [95 %-KI 1,3–7,4]). Knorpelschäden sind signifikant mit der Ausbildung von BML assoziiert (p < 0,001). Die OR beträgt dabei 5,5 (95 %-KI 1,3–22,5). Ebenso ist das Vorhandensein einer radiologischen Arthrose signifikanter assoziierter Faktor (OR = 3,6 [95 %-KI 1,2–10,6]). Das Vorhandensein bzw. die Progression von BML ist ein signifikanter Risikofaktor für eine Arthroseprogression über einen Zeitraum von ca. 3 Jahren. Dabei beträgt bei relativ guter Übereinstimmung die OR = 4,4 (95 %-KI 3,1–6,4). Schlussfolgerungen: Die Ergebnisse unserer Literaturrecherche haben gezeigt, dass BML ein wichtiges Symptom beim degenerativ veränderten Kniegelenk sind. Sie geben Anlass dafür, dass dieses MRT-Symptom ein wesentlicher Prädiktor für die Arthroseprogression ist. Inwieweit dies Einfluss auf die Prognose verschiedener konservativer oder operativer Therapieverfahren im Einzelfall hat, ist jedoch bislang unbekannt.

Abstract

Aim: The objective of this systematic review and meta-analysis is to obtain information about risks and associated factors for knee symptoms and the progression of osteoarthritis in idiopathic bone marrow lesion (BML). Materials and Methods: The primary search on 31. 12. 2013 included the databases PubMed, EMBASE, Web of Science and Cochrane by the search strategy [[bone marrow edema] AND [knee]]. This review was continuously updated up to 31. 10. 2015. Results: A total of 30 studies (from 1331 primary findings) were included in the final evaluation. The mean frequency of BML in all studies was 37.2 %. The occurrence of BML was strongly dependent on the MRI technique used (1.0 to 3.0 T). In longitudinal studies, the incidence of BML was 3.2 (95 % CI 1.7–6.3)/1000 person-months. Weakly associated factors included female gender (OR = 1.3 [95 % CI 1.1–1.7], p = 0.009), increasing age (OR = 1.05 [95 % CI 0.9–1.3], p = 0.127), and overweight or obesity (OR = 1.1 [95 % CI 1.1–1.2]; p < 0.01). BMLs are significantly associated with cartilage lesions (OR = 5.5 [95 % CI 1.3–22.5]). Radiological osteoarthritis is also significantly associated with the development of BML (OR = 3.6 [95 % CI 1.2–10.6]) and the progression of osteoarthritis within a 3-year interval (OR = 4.4 [95 % CI 3.1–6.4]). Conclusions: The occurrence of BML is an important index for severe degenerative pathologies in the knee. It appears that MRT symptoms predict the progression of the disease. The clinical relevance and possible consequences for treatment are unclear.

Schlüsselwörter

Knie - Knochenmarködem - Review

Key words

knee - bone marrow lesion - review
 

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