Fokale Knorpelschäden des medialen Gelenkkompartiments: Prädiktoren für die Progression der Kniearthrose

Zusammenfassung

Zielsetzung: Ziel dieser Untersuchung war es, die Progredienz der Arthrose (Endstadium mit der Notwendigkeit der Endoprothesenimplantation) bei fokalen Knorpelschäden des medialen Gelenkkompartiments zu ermitteln. Zudem sollten weitere Faktoren, welche die Arthroseinzidenz mitbestimmen und mögliche Prädiktoren hierfür sein können, ermittelt werden. Material und Methode: Bei insgesamt 115 Patienten mit fokalen Knorpelschäden im Bereich des medialen Kniegelenkkompartiments wurde eine Arthroskopie durchgeführt. Im 10-Jahres-Follow-up wurde die Rate der Endoprothesenkonversion bestimmt und Faktoren für die Arthroseprogression ermittelt. Ergebnisse: Bei 35 Patienten (30,4 %) erfolgte im Nachbeobachtungszeitraum eine Konversion zur Endoprothese. Das durchschnittliche endoprothesenfreie Überleben betrug 93,2 Monate (95 %-KI 85,4–109,0). Keinen Einfluss auf die notwendige Konversion hatten Knorpelschäden im Bereich der Patella, im lateralen Gelenkbereich, aber auch nicht Schäden am Femur. Dagegen waren signifikante Faktoren für eine spätere Endoprothesenkonversion höheres Lebensalter, weibliches Geschlecht, Übergewicht oder Adipositas, Ausmaß der Meniskusschädigung, Gelenkspaltverschmälerung. Vor allem fokale Knorpelschäden im Bereich der Tibia, hier assoziiert mit dem Durchmesser der Defekte, bestimmten die Arthroseprogression. Schlussfolgerungen: Fokale Knorpelschäden im Bereich des medialen Gelenksraums führen in einem Drittel der Fälle innerhalb eines 10-Jahres-Zeitraums zu einer starken Arthroseprogredienz, welche die Versorgung mit einer Endoprothese erforderlich macht. Neben allgemeinen Faktoren (weibliches Geschlecht, lange Anamnesedauer) sind vor allem große tibiale Defekte und der begleitende Meniskusschaden dafür verantwortlich. Diese Faktoren sind einerseits bei künftiger Indikationsstellung zu beachten, andererseits sollte in Zukunft der tibiale Knorpelschaden, aber auch der Meniskusverlust mehr Beachtung finden.

Abstract

Aim: The aim of this study was to evaluate the progression of osteoarthritis (end-stage disease with a requirement for arthroplasty) in patients with focal cartilage defects of the medial knee compartment.

Material and Methods: Patients (n = 115) with focal cartilage lesions of the medial knee compartment underwent arthroscopy. The follow-up was performed 10 years after the operation to determine the rate of arthroplasty conversion and to evaluate associated factors. Results: In a total of 35 cases an arthroplasty was needed (30.4 %). The mean survival to arthroplasty was 93.2 (95 % CI 85.4–109.0) months. Cartilage defects within the femur and cartilage lesions within the patella and the lateral did not influence the OA progression. Among the significant risk factors for OA progression were higher patient age, female gender, overweight or obesity and severity of meniscal damage. The most important risk factor was the occurrence and the extent of tibial cartilage defects. Conclusions: In the natural course, about 30 % of patients with focal cartilage defects of the medial knee compartment undergo rapid OA progression (arthroplasty as end-stage of the disease). There are general risk factors (age, female gender and obesity) but also local risk factors. Furthermore, tibial defects and the extent of meniscus loss influence the outcome significantly. These general and local factors should be more carefully estimated or addressed in future clinical and scientific work.

Schlüsselwörter

Knie - Arthroskopie - Knorpelschaden

Key words

knee - arthroscopy - cartilage defect

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