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Therapie der Osteochondrosis dissecans des Kniegelenks

Treatment of Osteochondritis dissecans of the knee joint

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Zusammenfassung

Die Osteochondrosis dissecans (OD) ist eine Erkrankung des subchondralen Knochens, die in 4 Stadien verläuft und bis zur Ablösung eines osteochondralen Fragments führen kann. Typische Lokalisation ist der mediale Femurkondylus. Grundsätzlich wird zwischen der juvenilen und der adulten Form unterschieden. Die Prognose und Therapie ist alters- und stadienabhängig.

Die Prognose ist in den stabilen Stadien I und II, bei typischer Lokalisation und bei noch offenen Epiphysenfugen günstig. Deshalb sollte in diesen Fällen immer mit einer konservativen Therapie begonnen werden. Kommt es hierunter nicht zur Ausheilung, ist die Anbohrung indiziert. In den Stadien III und IV ist bei instabilem bzw. bereits abgelöstem Dissekat in der Regel eine operative Therapie erforderlich. Aufgrund der schlechten Prognose bei alleiniger Entfernung des Dissekats sollte entweder die Refixation eines noch intakten Fragments oder die biologische Rekonstruktion der Gelenkfläche versucht werden.

Abstract

Osteochondritis dissecans (OD) is a lesion of the subchondral bone which can result in sequestration of the osteochondral lesion. It is categorized into 4 stages, and juvenile and adult forms depending on the distal femoral physis maturity. Prognosis and treatment depends on age and stage.

Prognosis is favorable in stable lesions (stage I and II) at typical location (medial femoral condyle) in a child with open physes. Therefore non-operative treatment is indicated. If there is no response to non-operative treatment drilling to create channels for potential revascularization can be done. In unstable lesions (stage III and IV) operative treatment is necessary. Long-term results after excision of the fragment with or without drilling of the defect site are poor. Therefore refixation of an intact osteochondral fragment or biologic reconstruction should be tried.

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  1. Orthopädische Klinik, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    J. Lützner, J. Mettelsiefen, K.P. Günther & F. Thielemann

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  1. J. Lützner
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  2. J. Mettelsiefen
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  3. K.P. Günther
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Lützner, J., Mettelsiefen, J., Günther, K. et al. Therapie der Osteochondrosis dissecans des Kniegelenks. Orthopäde 36, 871–880 (2007). https://doi.org/10.1007/s00132-007-1130-3

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