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Orthopädie und Unfallchirurgie up2date 2017; 12(02): 179-197
DOI: 10.1055/s-0042-116504
Beckengürtel und untere Extremität
Georg Thieme Verlag KG Stuttgart · New York

Knorpelverletzungen am Kniegelenk

Hagen Schmal
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Publication History

Publication Date:
08 May 2017 (online)

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Zu den wichtigsten Risikofaktoren einer sekundären Gonarthrose gehören Knorpelverletzungen am Kniegelenk. Knorpelverletzungen treten in der Regel nicht allein auf, sondern begleiten Bandverletzungen oder sind Teil einer intraartikulären Fraktur. Dieser Artikel beleuchtet die Ursachen, das diagnostische Vorgehen und die therapeutischen Optionen inklusive Nachbehandlung bzw. Rehabilitation bei Knorpelverletzungen des Kniegelenks.
Kernaussagen

  • Knorpelverletzungen gehören am Kniegelenk zu den wichtigsten Risikofaktoren einer sekundären Gonarthrose.

  • Ursachen sind:

    • Kniedistorsionen

    • intraartikuläre Frakturen

    • Patellaluxationen

    • Knieluxationen

  • Ein verletztes Knie mit Hämarthros muss klinisch und radiologisch abgeklärt werden.

  • Bei intraartikulären Frakturen ist der Knorpel immer verletzt, weshalb diese anatomisch reponiert und stabil fixiert werden müssen; die Beseitigung einer begleitenden ligamentären Instabilität ist ebenso Teil der Behandlung.

  • Osteochondrale Abscherungen, deren Größe eine Fixierung erlauben, sollen ebenso reponiert und stabilisiert werden.

  • Bei der Therapie von Knorpelläsionen außerhalb der akuten Phase kommen in Abhängigkeit von Tiefe und Ausdehnung chirurgische Techniken zur Anwendung wie

    • die Mikrofrakturierung,

    • die ACT und

    • die Mosaikplastik.

  • Die Nachbehandlung sollte phasenadaptiert verlaufen:

    • Anpassungsphase (Phase 1)

    • Rehabilitationsphase (Phase 2)

    • Rückkehr zur normalen Aktivität (Phase 3)

 

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