PDF herunterladen
Z Orthop Unfall 2024; 162(01): 93-107
DOI: 10.1055/a-2012-2473
CME-Fortbildung

Isolierte Patellofemoralarthrose

Isolated Patellofemoral Osteoarthritis
Simone Beischl
,
Ingo J. Banke
,
Rüdiger von Eisenhart-Rothe
,
Vanessa Twardy
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Die isolierte Patellofemoralarthrose ist eine komplexe Pathologie. Sie tritt gehäuft bei Frauen über 40 Jahren auf, ist mit einem hohen Leidensdruck verbunden und erfordert eine stadiengerechte Therapie. Die Ursachen einer femoropatellaren Degeneration sind vielfältig. Dieser Beitrag soll eine strukturierte Übersicht zu Symptomatik, Diagnostik und stadiengerechter Therapie der Patellofemoralarthrose liefern.

Abstract

Isolated patellofemoral osteoarthritis is a complex pathology. It occurs frequently in women over 40 years and leads to a high degree of suffering. The causes of femoropatellar degeneration are manifold and require stage-specific therapy. This is very challenging for the treating physician. This article is intended to provide a structured overview of the symptoms, diagnostics and stage-specific therapy of patellofemoral osteoarthritis.

Kernaussagen

  • Die häufigste Form der Patellofemoralarthrose (PFA) ist die sekundäre Arthrose, verursacht durch Malalignment/Maltracking der Patella (meist aufgrund patellofemoraler Instabilität).

  • Typisches Symptom sind ein vorderer/ventraler Knieschmerz, verstärkt beim Treppenhinabsteigen oder In-die-Hocke-Gehen.

  • Bei der klinischen Untersuchung sollten im Rahmen der Beurteilung von Stand- und Gangbild auch mögliche Achs- oder Torsionsfehlstellungen erfasst werden.

  • Konventionelle Röntgendiagnostik, ggf. erweitert durch MRT, gilt als Goldstandard, Computertomografie und Rotationsanalyse sind Einzelfällen vorbehalten.

  • Die konservative Therapie über mehrere Monate mit Koordinationsschulung, Muskelkräftigung, Dehnung/Lockerung verkürzter Muskelgruppen, Körpergewichtsmanagement und Belastungsmodifikation ist Mittel der Wahl als First-Line-Therapie.

  • Gelenkerhaltende weichteilige/knöcherne Eingriffe sind nur bei fehlender/milder PFA (Iwano-Stadium ≤ 2) indiziert.

  • Bei höhergradiger PFA (Iwano-Stadium > 2) sind Inlay-Prothesen möglicherweise den Onlay-Prothesen überlegen hinsichtlich der tibiofemoralen Arthroseprogression.

  • Bei generalisierter Kniearthrose ist der alleinige patellofemorale Oberflächenersatz obsolet.

Schlüsselwörter

Patellofemoralarthrose - patellofemoraler Gelenkersatz - Patellofemoralgelenk - patellofemoraler Schmerz - Patella

Keywords

patellofemoral arthrosis - patellofemoral arthroplasty - patellofemoral joint - patellofemoral pain - patella


Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Lonner JH. Patellofemoral arthroplasty. Orthopedics 2010; 33: 653
    CrossrefPubMedSuche in Google Scholar
  • 2 Hanna F, Wluka AE, Ebeling PR. et al. Determinants of change in patella cartilage volume in healthy subjects. J Rheumatol 2006; 33: 1658-1661
    PubMedSuche in Google Scholar
  • 3 Hinman RS, Crossley KM. Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology 2007; 46: 1057-1062
    CrossrefPubMedSuche in Google Scholar
  • 4 Donell ST, Glasgow MM. Isolated patellofemoral osteoarthritis. Knee 2007; 14: 169-176
    CrossrefPubMedSuche in Google Scholar
  • 5 Keshmiri A, Imhoff AB, Dirisamer F. Patellofemorale Arthrose. Arthroskopie 2020; 33: 441-447
    CrossrefPubMedSuche in Google Scholar
  • 6 Frings J, Balcarek P, Tscholl P. et al. Conservative versus surgical treatment for primary patellar dislocation. Dtsch Arztebl Int 2020; 117: 279-286
    CrossrefPubMedSuche in Google Scholar
  • 7 Kolb A, Willegger M, Chiari C. et al. Behandlung der Patellainstabilität. Z Orthop Unfall 2022; 160: 463-475
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 Vaitl T, Grifka J, Bolm-Audorff U. et al. Patellaformen. Trauma Berufskrankh 2012; 14: 437-438
    CrossrefPubMedSuche in Google Scholar
  • 9 Seitlinger G, Beitzel K, Scheurecker G. et al. Das schmerzhafte Patellofemoralgelenk. Orthopäde 2011; 40: 353-370
    CrossrefPubMedSuche in Google Scholar
  • 10 Iwano T, Kurosawa H, Tokuyama H. et al. Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 1990; (252) 190-197
    PubMedSuche in Google Scholar
  • 11 Seitlinger G, Scheurecker G, Högler R. et al. Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012; 40: 1119-1125
    CrossrefPubMedSuche in Google Scholar
  • 12 Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 2006; 14: 707-712
    CrossrefPubMedSuche in Google Scholar
  • 13 Laskin RS, van Steijn M. Total knee replacement for patients with patellofemoral arthritis. Clin Orthop Relat Res 1999; (367) 89-95
    PubMedSuche in Google Scholar
  • 14 Bannuru RR, Osani MC, Vaysbrot EE. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27: 1578-1589
    Suche in Google Scholar
  • 15 Werner S, Arvidsson H, Arvidsson I. et al. Electrical stimulation of vastus medialis and stretching of lateral thigh muscles in patients with patello-femoral symptoms. Knee Surg Sports Traumatol Arthrosc 1993; 1: 85-92
    CrossrefPubMedSuche in Google Scholar
  • 16 Ahmed AM, Burke DL, Hyder A. Force analysis of the patellar mechanism. J Orthop Res 1987; 5: 69-85
    CrossrefPubMedSuche in Google Scholar
  • 17 Becher C, Pagensteert G, Wagner D. Vorderer Knieschmerz. Arthroskopie 2020; 33: 433-440
    CrossrefPubMedSuche in Google Scholar
  • 18 Santos TR, Oliveira BA, Ocarino JM. et al. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther 2015; 19: 167-176
    CrossrefPubMedSuche in Google Scholar
  • 19 Lun V, Meeuwisse WH, Stergiou P. et al. Relation between running injury and static lower limb alignment in recreational runners. Br J Sports Med 2004; 38: 576-580
    CrossrefPubMedSuche in Google Scholar
  • 20 Petersen W, Ellermann A, Rembitzki IV. et al. Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial. Arch Orthop Trauma Surg 2016; 136: 975-982
    CrossrefPubMedSuche in Google Scholar
  • 21 Deutsche Gesellschaft für Orthopädie und Unfallchirurgie e. V. (DGOU). S2k-Leitlinie Gonarthrose. Registernummer 187–050, Stand: 30.11.2017, gültig bis 29.11.2022 (derzeit in Überarbeitung). Zugriff am 06. November 2023 unter: https://register.awmf.org/de/leitlinien/detail/033–004
    PubMed
  • 22 Fransen M, McConnell S, Harmer AR. et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med 2015; 49: 1554-1557
    CrossrefPubMedSuche in Google Scholar
  • 23 Golightly YM, Allen KD, Caine DJ. A comprehensive review of the effectiveness of different exercise programs for patients with osteoarthritis. Phys Sportsmed 2012; 40: 52-65
    CrossrefPubMedSuche in Google Scholar
  • 24 Lim JY, Tchai E, Jang SN. Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. PM R 2010; 2: 723-731
    CrossrefPubMedSuche in Google Scholar
  • 25 Waller B, Ogonowska-Slodownik A, Vitor M. et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Phys Ther 2014; 94: 1383-1395
    CrossrefPubMedSuche in Google Scholar
  • 26 Lake DA, Wofford NH. Effect of therapeutic modalities on patients with patellofemoral pain syndrome: a systematic review. Sports Health 2011; 3: 182-189
    CrossrefPubMedSuche in Google Scholar
  • 27 Vickers AJ, Cronin AM, Maschino AC. et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012; 172: 1444-1453
    CrossrefPubMedSuche in Google Scholar
  • 28 Corbett MS, Rice SJ, Madurasinghe V. et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage 2013; 21: 1290-1298
    CrossrefPubMedSuche in Google Scholar
  • 29 Micke O, Ugrak E, Bartmann S. et al. Radiotherapy for calcaneodynia, achillodynia, painful gonarthrosis, bursitis trochanterica, and painful shoulder syndrome – Early and late results of a prospective clinical quality assessment. Radiat Oncol 2018; 13: 71
    CrossrefPubMedSuche in Google Scholar
  • 30 Kolb A, Willegger M, Chiari C. et al. Behandlung der Patellainstabilität. Z Orthop Unfall 2021; 160: 463-475
    Thieme ConnectPubMedSuche in Google Scholar
  • 31 Ouyang Z, Yang BH, Zhang B. et al. [Arthroscopic denervation of patella combined with microfracture for patellofemoral arthritis]. Zhongguo Gu Shang 2019; 32: 407-411
    CrossrefPubMedSuche in Google Scholar
  • 32 Zhao G, Liu Y, Yuan B. et al. Arthroscopic patelloplasty and circumpatellar denervation for the treatment of patellofemoral osteoarthritis. Chin Med J 2015; 128: 79-84
    CrossrefPubMedSuche in Google Scholar
  • 33 Dejour H, Walch G, Nove-Josserand L. et al. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2: 19-26
    CrossrefPubMedSuche in Google Scholar
  • 34 McWalter EJ, Cibere J, MacIntyre NJ. et al. Relationship between varus-valgus alignment and patellar kinematics in individuals with knee osteoarthritis. J Bone Joint Surg Am 2007; 89: 2723-2731
    CrossrefPubMedSuche in Google Scholar
  • 35 Imhoff AB, Feucht MJ, Meidinger G. et al. Prospective evaluation of anatomic patellofemoral inlay resurfacing: clinical, radiographic, and sports-related results after 24 months. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1299-1307
    CrossrefPubMedSuche in Google Scholar
  • 36 Feucht MJ, Cotic M, Beitzel K. et al. A matched-pair comparison of inlay and onlay trochlear designs for patellofemoral arthroplasty: no differences in clinical outcome but less progression of osteoarthritis with inlay designs. Knee Surg Sports Traumatol Arthrosc 2017; 25: 2784-2791
    CrossrefPubMedSuche in Google Scholar
  • 37 Benignus C, Meier M, Best R. et al. Wenn nichts mehr geht: Der patellofemorale Gelenkersatz. Sportschaden 2021; 35: 227-233
    Thieme ConnectPubMedSuche in Google Scholar
  • 38 Lustig S, Magnussen RA, Dahm DL. et al. Patellofemoral arthroplasty, where are we today?. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1216-1226
    CrossrefPubMedSuche in Google Scholar
  • 39 Hernigou P, Caton J. Design, operative technique and ten-year results of the Hermes™ patellofemoral arthroplasty. Int Orthop 2014; 38: 437-442
    CrossrefPubMedSuche in Google Scholar
  • 40 Hoogervorst P, de Jong RJ, Hannink G. et al. A 21% conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years. Int Orthop 2015; 39: 1857-1864
    CrossrefPubMedSuche in Google Scholar
  • 41 Ackroyd CE, Newman JH, Evans R. et al. The Avon patellofemoral arthroplasty: five-year survivorship and functional results. J Bone Joint Surg Br 2007; 89: 310-315
    CrossrefPubMedSuche in Google Scholar
  • 42 Cartier P, Sanouiller JL, Khefacha A. Long-term results with the first patellofemoral prosthesis. Clin Orthop Relat Res 2005; 436: 47-54
    CrossrefPubMedSuche in Google Scholar
  • 43 Dahm DL, Al-Rayashi W, Dajani K. et al. Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop 2010; 39: 487-491
    PubMedSuche in Google Scholar
  • 44 Odgaard A, Madsen F, Kristensen PW. et al. The Mark Coventry Award: patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res 2018; 476: 87-100
    CrossrefPubMedSuche in Google Scholar
  • 45 Mont MA, Haas S, Mullick T. et al. Total knee arthroplasty for patellofemoral arthritis. J Bone Joint Surg Am 2002; 84: 1977-1981
    CrossrefPubMedSuche in Google Scholar
  • 46 O’Donnell T, Neil MJ. The Repicci II® unicondylar knee arthroplasty: 9-year survivorship and function. Clin Orthop Relat Res 2010; 468: 3094-3102
    CrossrefPubMedSuche in Google Scholar