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Aktuelle Traumatol 2006; 36(6): 259-271
DOI: 10.1055/s-2006-924755
Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Knorpelschaden und Gonarthrose

Teil II: Epidemiologie und Diagnostik von chondralen Schäden und der GonarthroseCartilage Lesions and GonarthritisPart II: Epidemiology and Diagnosis of Chondral Lesions and GonarthritisG. Spahn1
  • 1Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach
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Publikationsverlauf

Publikationsdatum:
02. April 2007 (online)

    Lizenzen und Reprints

Zusammenfassung

Die Prävalenz von Kniebeschwerden ist mit durchschnittlich 30 % hoch. Mit steigendem Lebensalter sind Kniebeschwerden häufig mit Knorpelschäden oder einer radiologisch nachweisbaren Arthrose assoziiert. Die Arthroseinzidenz steigt ab dem 40. Lebensjahr um ca. 1 - 2 Prozent jährlich. Derzeit gibt es nur wenige verlässliche Daten über signifikante Risikofaktoren für das Entstehen einer Gonarthrose. Knorpelschäden treten in vier Stadien auf: Grad I oberflächliche Erweichung und Aufrauung, Grad II Läsionen die ca. die Hälfte der Knorpeldicke alterieren, Grad III Läsionen die bis zum subchondralen Knochen reichen und Grad IV die Knorpelglatze. Die radiologische Diagnostik ist nach wie vor Methode der Wahl bei der Bestimmung des Arthrosegrades. Die Kernspindiagnostik hingegen ist das einzige bildgebende Verfahren, mit dem es möglich ist alle Knorpelflächen bildlich darzustellen. Während die Diagnostik tiefer chondraler Läsionen damit recht gut möglich ist, versagt die Methode dagegen gelegentlich bei der Diagnostik initialer Knorpelschäden. Die Arthroskopie gilt als die sicherste und objektivste Methode zur Beurteilung der Knorpelschäden, wenngleich die diagnostische Sicherheit von der Erfahrung des Untersuchers abhängt und letztlich auch ein subjektives Verfahren darstellt. Arthrosescores (mit subjektiven und objektiven Parametern) reflektieren häufig am besten die Schwere der Erkrankung.

Abstract

Knee pain has a high prevalence (about 30 %) in the community. There is a positive correlation between increasing age and the frequency of cartilage lesions as wells as manifest gonarthritis. In patients over 40 years is an incidence of gonarthritis of 1 - 2 % per year. There are only little information's about really and significantly risk factors for development of gonarthritis. Chondral lesions generally are classified into four degrees: grad I means superficial softening and fissuring, grad II means lesions up to the half of the thickness of the cartilage layer, grade III means lesions up to the subchondral bone and finally grad IV means the complete ulcer with widely open laying subchondral bone. The radiography is the golden standard for classifying the grad of gonarthritis. The magnetic resonance tomography against is the only minimal-invasive evaluation for exactly diagnosis of cartilage lesions. Still this measure is mostly sufficient in evaluation of high grade cartilage lesions but it has its limitations in the diagnosis of low grade chondral damages. Arthroscopy means to be the mostly objective method for evaluation of chondral lesions. But also arthroscopy has its own limitations. The judgements of arthroscopic evaluation depend on the surgeon experiences and it is finally also a subjective method. The disease cartilage lesion respectively gonarthritis is characterized by a large number of individual subjective complaints and objective parameters. The mostly gonarthritis scores often ideally reflect the severe of the disease.

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Dr. med. Gunter Spahn

Praxisklinik für Unfallchirurgie und Orthopädie

Sophienstraße 16

99817 Eisenach

Telefon: 0 36 91/7 35 00

Fax: 0 36 91/73 50 11

eMail: spahn@pk-eisenach.de

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