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Wann ist eine Knorpelreparatur erfolgreich?

When is cartilage repair successful?

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Zusammenfassung

Die Therapie fokaler Knorpelschäden ist weiterhin eine klinische Herausforderung. Nach erfolgter Sanierung gilt es daher besonders, Erfolg und Misserfolg zu evaluieren und den Verlauf standardisiert und somit reproduzierbar zu beurteilen. Dieser Artikel bietet einen Überblick über gängige Reparaturverfahren und deren Charakteristika in der Magnetresonanztomographie. Nach einer erfolgreichen Knorpelreparatur ist eine vollständige, aber nicht hypertrophe Füllung des Knorpeldefekts das primäre Kriterium. Zum umgebenden Nativknorpel ist außerdem eine durchgehende Integration des Transplantats vordergründig. Im weiteren postoperativen Verlauf sollte das Transplantat außerdem ein im Vergleich zu nativem Knorpel isointenses Signalverhalten zeigen. Häufig beobachtete Komplikationen sind zentrale Osteophyten, subchondrale Defekte, Zysten, chronifizierte Knochenmarksödeme, Gelenksergüsse oder Adhäsionen. Die radiologische Beurteilung dieser postoperativen Veränderungen und deren Bewertung müssen immer unter Berücksichtigung des jeweiligen Reparaturverfahrens erfolgen.

Abstract

Focal cartilage lesions are a cause of long-term disability and morbidity. After cartilage repair, it is crucial to evaluate long-term progression or failure in a reproducible, standardized manner. This article provides an overview of the different cartilage repair procedures and important characteristics to look for in cartilage repair imaging. Specifics and pitfalls are pointed out alongside general aspects. After successful cartilage repair, a complete, but not hypertrophic filling of the defect is the primary criterion of treatment success. The repair tissue should also be completely integrated to the surrounding native cartilage. After some months, the transplants signal should be isointense compared to native cartilage. Complications like osteophytes, subchondral defects, cysts, adhesion and chronic bone marrow edema or joint effusion are common and have to be observed via follow-up. Radiological evaluation and interpretation of postoperative changes should always take the repair method into account.

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Authors and Affiliations

  1. Exzellenzzentrum Hochfeld-MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich

    M. Raudner, S. Röhrich, M. Zalaudek &  S. Trattnig

  2. Universitätsklinik für Orthopädie, Medizinische Universität Wien, Währinger–Gürtel 18–20, 1090, Wien, Österreich

    M. M. Schreiner

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  1. M. Raudner
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  5. S. Trattnig
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Correspondence to S. Trattnig.

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Interessenkonflikt

M. Raudner, M.M. Schreiner, S. Röhrich, M. Zalaudek und S. Trattnig geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Raudner, M., Schreiner, M.M., Röhrich, S. et al. Wann ist eine Knorpelreparatur erfolgreich?. Radiologe 57, 907–914 (2017). https://doi.org/10.1007/s00117-017-0305-0

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