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Z Orthop Ihre Grenzgeb 2006; 144(4): R63-R81
DOI: 10.1055/s-2006-924323
Orthopädie-Refresher

Georg Thieme Verlag KG Stuttgart · New York

Osteochondrosis dissecans des Kniegelenkes

Osteochondritis Dissecans of the Knee JointJ. P. Petersen1 , J. Steinhagen1 , P. Catala-Lehnen2 , J. Bruns1
  • 1Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf
  • 2Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf
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Publication History

Publication Date:
06 September 2006 (online)

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Zusammenfassung

Die Osteochondrosis dissecans ist mit einer Prävalenz von 0,01 - 0,06 % keine seltene Erkrankung. Sie betrifft am häufigsten Männer zwischen dem 16. und dem 36. Lebensjahr. Die Hauptlokalisation dieser stadienhaft verlaufenden Erkrankung ist in der westlichen Welt mit 75 % das Kniegelenk und hier mit 70 bis 80 % die mediale Kondyle. Die Ätiologie ist weitgehend unbekannt. Diskutiert werden genetische Defekte, lokale Ischämien, Ossifikationsstörungen oder vorausgegangene Mikrotraumen.

Pathogenetisch lässt sich die Erkrankung in 4 Stadien einteilen, wobei das initiale Stadium I durch ein subchondrales Ödem gekennzeichnet ist und unbehandelt bis zum Stadium IV führen kann, in dem das Dissekat komplett aus dem knöchernen und knorpeligen Verbund gelöst ist.

An den Stadien orientiert sich auch die Therapie. Können im Stadium I konservative Maßnahmen noch zu einer kompletten Heilung führen, so sollte in der Regel ab Stadium II operativ interveniert werden, wobei bei noch intakter Knorpeloberfläche retrograde, bei Verletzung der chondralen Oberfläche anterograde Verfahren angewendet werden sollten. Hierbei kommen eine Refixation des Dissekates sowie chondrale und osteochondrale Transplantationsverfahren in Betracht.

Summary

Osteochondritis dissecans is a disorder with a prevalence of 0.01 to 0.06 %. Men between 16 and 36 years of age are most commonly affected by it. In the western hemisphere, the knee is affected by this progressive disorder in 75 % of the cases, specifically the medial femoral condyle (70 - 80 %). The etiology is uncertain, although genetic defects, micro-trauma, ossification disorders and ischemia have been implicated.

Pathogenetically, Osteochondritis dissecans is classified in four stages, whereas in stage one, there is merely a subchondrial edema. Without therapy this could lead to stage 4, with a free osteochondral joint fragment.

Treatment is analogous with the stage of the disorder. Whereas conservative treatment may yield full recovery during stage 1, starting in stage 2, invasive treatment should be considered. When the cartilage surface remains intact retrograde procedures are indicated. If the cartilage is injured anterograde therapies, like the chondral or osteochondral transplantation, should be used.

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Dr. med. J. P. Petersen Wissenschaftlicher Mitarbeiter

Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie

Martinistraße 52

20246 Hamburg

Email: jpetersen@uke.uni-hamburg.de

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