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Die Meniskusläsion – ein präarthrotischer Zustand des Kniegelenks

Meniscal lesion. A pre-osteoarthritic condition of the knee joint

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An Erratum to this article was published on 21 September 2017

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Zusammenfassung

Hintergrund

Es besteht ein enger Zusammenhang zwischen Meniskusschäden und Gelenkknorpel sowie zwischen Meniskus(teil)resektionen und einer Arthroseentstehung.

Ziel der Arbeit

Mit einem Focus auf die therapeutischen Konsequenzen für orthopädische Chirurgen werden die strukturellen und funktionellen Zusammenhänge zwischen Meniskusrissen/-extrusion und Knorpelverlust sowie der Effekt einer Meniskusresektion bzw. -reparatur auf die Arthroseentstehung dargestellt.

Material und Methoden

Selektive Literaturrecherche und Implementierung eigener Forschungsergebnisse.

Ergebnisse

Das enge topografische und funktionelle Zusammenspiel zwischen den Menisken und dem tibiofemoralen Gelenkknorpel ist Grundlage für den klinisch wichtigen Zusammenhang von Meniskusschäden und Knorpeldegeneration. Insbesondere die degenerative Meniskusläsion ist aufgrund ihrer engen Verbindung zum tibiofemoralen Arthroseprozess als ein präarthrotischer Zustand anzusehen. Eine Meniskusextrusion ist häufig mit tibiofemoraler Arthrose assoziiert. Auch großflächige Knorpeldefekte können Meniskusläsionen verursachen. Eine partielle Meniskektomie ist stark mit der Inzidenz von Arthrose und einem höheren Risiko der Progression vergesellschaftet. Vor allem nach Teilresektion des Außenmeniskus sind die klinischen Ergebnisse problematisch. Obwohl aktuell der Nutzen einer arthroskopischen Teilresektion für degenerative Meniskusläsionen kontrovers diskutiert wird, liegen hierzu bislang keine Langzeitstudien vor. Eine Vielzahl von Studien unterstreicht den mittelfristigen Wert der Meniskusreparatur im Vergleich zur partiellen Meniskusresektion. Kombinierte Meniskus- und Knorpelschäden sind komplexe Fälle, und der Effekt einer zeitgleichen Therapie ist nicht gesichert.

Diskussion

Die Erhaltung des Meniskus ist der erste Schritt zur Knorpelreparatur. Randomisierte und kontrollierte Langzeitstudien werden bessere Auskunft über die Konsequenzen von Meniskusteilresektion und -reparatur im Hinblick auf die Arthroseentwicklung geben.

Abstract

Background

A close relationship between meniscal damage and articular cartilage exist. Likewise, (partial) meniscectomy may lead to the development of osteoarthritis (OA).

Objectives

With a special emphasis on therapeutic consequences for orthopaedic surgeons, the structural and functional relationship between meniscal tears/extrusion and cartilage loss, and/or the effect of meniscectomy or meniscal repair on the development of OA, are emphasized.

Materials and methods

A selective literature review with implementation of own research findings.

Results

The close topographical and functional interplay between the menisci and the tibiofemoral cartilage is the basis for the clinically important relationship between meniscal damage and cartilage degeneration. In particular, due to its close connection to tibiofemoral OA, a degenerative meniscal lesion represents a pre-osteoarthritic condition. Meniscus extrusion is also often associated with tibiofemoral OA. Even large cartilage defects can cause meniscus lesions. Partial meniscectomy is strongly associated with the incidence and risk of progression of OA. Clinical results are particularly problematic after partial resection of the lateral meniscus. Although the use of arthroscopic partial resection for degenerative meniscal lesions has been controversially discussed, no long-term studies are available. A large number of studies emphasize the medium-term value of meniscus reconstruction compared to partial meniscus resection. Combined meniscus and cartilage damage are complex cases, and the value of a simultaneous therapy remains unclear.

Conclusions

Preserving the meniscus is the first step towards cartilage repair. Randomized and controlled studies will provide better information on the long-term outcomes of meniscal resection and repair with regard to OA development.

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Change history

  • 21 September 2017

    Erratum zu:

Abbreviations

COMP:

„cartilage oligomeric matrix protein“

MRT:

Magnetresonanztomographie

OA:

„development of osteoarthritis“

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Authors and Affiliations

  1. Lehrstuhl für Experimentelle Orthopädie und Arthroseforschung, Zentrum für Experimentelle Orthopädie, Universität des Saarlandes, Gebäude 37, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland

    L. Goebel, J. Reinhard &  H. Madry

  2. Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Gebäude 37–38, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland

    L. Goebel &  H. Madry

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  1. L. Goebel
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Correspondence to H. Madry.

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Interessenkonflikt

L. Goebel, J. Reinhard und H. Madry geben an, dass kein Interessenkonflikt besteht.

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

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Ein Erratum zu diesem Beitrag ist unter https://doi.org/10.1007/s00132-017-3476-5 zu finden.

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Goebel, L., Reinhard, J. & Madry, H. Die Meniskusläsion – ein präarthrotischer Zustand des Kniegelenks. Orthopäde 46, 822–830 (2017). https://doi.org/10.1007/s00132-017-3462-y

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