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Radiologische Bildgebung der Kniegelenkarthrose

Radiological imaging of osteoarthritis of the knee

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Zusammenfassung

Klinisches/methodisches Problem

Die Arthrose ist die häufigste chronische, altersassoziierte, degenerative Gelenkerkrankung, die zu typischer Knorpeldegradierung und verminderter Gelenkbeweglichkeit führt. Bei 70- bis 74-Jährigen liegt die Prävalenz einer Kniegelenkarthrose bei über 90%. Die demographische Altersentwicklung der westlichen Industrieländer prognostiziert einen deutlichen Anstieg der Arthroseinzidenz für die nächsten Jahrzehnte.

Radiologische Standardverfahren

Nach wie vor stellt die konventionelle projektionsradiographische Röntgenbildanalyse die einfachste und günstigste radiologische Modalität bei der Beurteilung und Verlaufskontrolle der Kniegelenkarthrose dar.

Methodische Innovationen

Das Röntgenbild birgt zunehmend in zahlreichen klinischen und wissenschaftlichen Situationen signifikante Limitierungen, welche durch moderne bildgebende Methoden wie der Magnetresonanztomographie (MRT) und Sonographie überwunden werden können.

Leistungsfähigkeit

Intravitale Knorpelbeurteilungen anhand spezieller bildgebender MRT-Methoden werden zunehmend in der Diagnostik und Verlaufskontrolle der Arthrose eingesetzt und könnten bei breiter klinischer Anwendung zukünftig zu einem Paradigmenwechsel bei der Behandlung arthrotischer Knorpelschäden führen. In diesem Übersichtsartikel sollen die wichtigsten radiologischen diagnostischen Merkmale der Kniegelenkarthrose und deren radiologisch Beurteilung dargestellt werden.

Empfehlung für die Praxis

Die demographische Altersentwicklung der westlichen Industrieländer prognostiziert einen deutlichen Anstieg der Arthroseinzidenz für die nächsten Jahrzehnte. Die systematische radiologische Beurteilung der Kniegelenkarthrose umfasst die Bestimmung der Gelenkkapselstrukturen, Synovia, Knorpeldicke, des Knorpelvolumens, eventueller Knorpeldefekte, des makromodularen Netzwerks des hyalinen Gelenkknorpels, eines Knochenmarködems, der Menisken und der artikulären Gelenkbänder. Moderne bildgebende Methoden wie die MRT und Sonographie sind in der Lage, die Schwächen der Projektionsradiographie zu eliminieren und das Kniegelenk mit seinen knöchernen, knorpeligen, ligamentösen und weichteildichten Strukturen detailliert abzubilden sowie den Schweregrad der Kniearthrose quantitativ zu beurteilen.

Abstract

Clinical/methodical issue

Osteoarthritis is the most common degenerative age-related joint disease leading to typical degradation of articular cartilage with severe pain and limitation of joint motion.

Standard radiological methods

Although knee radiographs are widely considered as the gold standard for the assessment of knee osteoarthritis in clinical and scientific settings they increasingly have significant limitations in situations when resolution and assessment of cartilage is required.

Methodical innovations

Analysis of osteoarthritis of the knee with conventional x-ray is associated with many technical limitations and is increasingly being replaced by high-quality assessment using magnetic resonance imaging (MRI) or sonography both in the clinical routine and scientific studies.

Performance

Novel imaging modalities such as MRI or ultrasound enable in vivo visualization of the quality of the cartilaginous structure and bone as well as all articular and periarticular tissue. Therefore, the limitations of radiographs in assessment of knee osteoarthritis could be overcome by these techniques. This review article aims to provide insights into the most important radiological features of knee osteoarthritis and systematic visualization with different imaging approaches.

Practical recommendations

The demographic development in western industrialized countries predicts an increase of ageing-related osteoarthritis of the knee for the next decades. A systematic radiological evaluation of patients with knee osteoarthritis includes the assessment of the periarticular soft tissue, cartilaginous thickness, cartilage volume, possible cartilage defects, the macromodular network of hyaline cartilage, bone marrow edema, menisci and articular ligaments. Modern imaging modalities, such as MRI and sonography allow the limitations of conventional radiography to be overcome and to visualize the knee structures in great detail to quantitatively assess the severity of knee osteoarthritis.

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Authors and Affiliations

  1. Department Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, A-6020, Innsbruck, Österreich

    M.C. Wick, W. Jaschke & A.S. Klauser

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  1. M.C. Wick
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  2. W. Jaschke
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  3. A.S. Klauser
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Correspondence to M.C. Wick.

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Wick, M., Jaschke, W. & Klauser, A. Radiologische Bildgebung der Kniegelenkarthrose. Radiologe 52, 994–1002 (2012). https://doi.org/10.1007/s00117-012-2365-5

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