Isolierte Patellofemoralarthrose

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

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