Der Unfallchirurg

, Volume 110, Issue 5, pp 414–424 | Cite as

Diagnostik von Knorpelschäden des Kniegelenks

Validität der klinischen, radiologischen und kernspintomographischen Diagnostik im Vergleich zur Arthroskopie
  • G. Spahn
  • R. Wittig
  • E. Kahl
  • H.M. Klinger
  • T. Mückley
  • G.O. Hofmann
Originalien

Zusammenfassung

Zielstellung

Anliegen der Arbeit war es, die Validität der präoperativen klinischen Untersuchung, der radiologischen Befunde und der MRT bei der Diagnostik chondraler Schäden des Kniegelenks im Vergleich zur Arthroskopie zu bestimmen.

Methode

Bei 721 Patienten mit Kniebeschwerden die 3 Monate oder länger andauerten, erfolgte die standardisierte klinische Diagnostik (Grinding-Test), die radiologische Standarddiagnostik (Standaufnahmen und Patella-Axial-Aufnahme) sowie die MRT-Untersuchung (T1- und T2-Wichtung). Alle Patienten wurden nachfolgend arthroskopiert. Mithilfe des Tasthakentests wurde die Schwere des Knorpelschadens nach der ICRS- (International-Cartilage-Repair-Society-)Klassifikation bestimmt. Abschließend wurden die Ergebnisse der präoperativen Diagnostik mit den arthroskopischen Befunden verglichen.

Ergebnisse

Der Grinding-Test hatte eine durchschnittliche Empfindlichkeit von 0,39 mit einer signifikanten höheren Häufigkeit bei tiefer gehender Knorpelschädigung (p<0,000). Bei 97,4% der Gelenkflächen ohne Knorpelpathologie war der radiologische Befund unauffällig. Subchondrale Sklerose und Exophyten kamen signifikant häufiger bei höhergradigen Knorpelschäden vor (p<0,000). Nur in 59,5% der Fälle wurden übereinstimmende Befunde zwischen MRT und Arthroskopie erhoben. Bei 36,6% wurden die Knorpelschäden im MRT überbewertet, bei 3,9% wurde der Knorpelschaden im MRT zu niedrig eingestuft. Überbewertungen kamen signifikant häufiger bei intaktem und niedriggradig geschädigtem Knorpel vor (p<0,000).

Schlussfolgerung

Klinische, radiologische und kernspintomographische Untersuchung stehen bei höhergradigen Knorpelschäden in relativ guter Korrelation mit den arthroskopischen Befunden, während bei intaktem Knorpel oder initialer Chondropathie falsch-positive Ergebnisse häufig sind.

Schlüsselwörter

Knie Arthroskopie Knorpel MRT Röntgen 

Evaluation of cartilage defects in the knee

Validity of clinical, magnetic-resonance-imaging and radiological findings compared with arthroscopy

Abstract

Background

The study was aimed to evaluate the validity of clinical, radiological and MRI examination for cartilage defects of the knee compared with arthroscopic finding.

Methods

Sevenhundred-seventy-two patients who were suffering from knee pain over more than 3 months were evaluated clinical (grinding-sign) and with radiography and magnetic resonance imaging (MRI) and subsequent arthroscopy.

Results

The grinding sign had a sensitivity of 0.39. The association of a positive grinding test with high grade cartilage defects was significant (p<0.000). In 97.4% an intact chondral surface correlated with a normal radiological finding. Subchondral sclerosis, exophytes and a joint space narrowing was significantly associated with high grade cartilage defects (p<0.000). The accuracy of MRI was 59.5%. The MRI resulted in an overestimation in 36.6% and an underestimation in 3.9%. False-positive results were significant more often assessed in low-grade cartilage defects (p<0.000).

Conclusions

Clinical signs, x-ray imaging and MRI correlate with arthroscopic findings in cases of deep cartilage lesions. In intact or low-grade degenerated cartilage often results an overestimating of these findings.

Keywords

Knee Arthroscopy Cartilage MRI X-ray 
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Notes

Danksagung

Herrn Dr. Fischer, radiologische Gemeinschaftspraxis Eisenach, danken wird für die Überlassung der MRT-Bilder

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • G. Spahn
    • 1
  • R. Wittig
    • 1
  • E. Kahl
    • 2
  • H.M. Klinger
    • 2
  • T. Mückley
    • 3
  • G.O. Hofmann
    • 3
  1. 1.Praxisklinik für Unfallchirurgie und OrthopädieEisenachDeutschland
  2. 2.Georg-August-UniversitätOrthopädische KlinikGöttingenDeutschland
  3. 3.Klinik für Unfall-, Hand- und WiederherstellungschirurgieKlinikum der Friedrich-Schiller-UniversitätJenaDeutschland

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