Skip to main content
Log in

Die patellofemorale Arthrose

Behandlungsmöglichkeiten

Patellofemoral arthritis

Treatment options

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Bis heute gehört die Therapie der isolierten patellofemoralen Arthrose (PFA) zu den komplexesten, da die Kinematik des patellofemoralen Gelenks (PFG) nicht nur durch das distale Femur direkt, sondern indirekt auch durch die Rotation der Hüfte, Achsdeformitäten, Fußstellung und passiven Weichteilfaktoren bestimmt wird. Während die primär traumatische Genese eher selten ist, führt die Kombination von akuter oder chronischer Instabilität und begleitender Druckerhöhung im PFG zu einer ausgeprägten PFA. Aus diesem Grund können nur Kombinationstherapien, die direkte und indirekte Ursachen gleichzeitig beheben, gute Erfolge vorweisen. Allerdings fehlen bis dato Studien und damit ein Goldstandard.

Es scheint notwendig und sinnvoll, bei der Behandlung der PFA die auslösende(n) Pathologie(n) genau zu identifizieren und entsprechend den individuellen Behandlungsplan zu gestalten.

Die Behandlung der PFA sollte zum einen aus der Behebung einer eventuellen Instabilität, zum anderen aus der Normalisierung des patellofemoralen Drucks und zusätzlich aus der Behandlung der Degeneration bestehen. Dies ist auch in den Fällen notwendig, bei denen eine partielle Prothese verwendet wird.

Abstract

The treatment of isolated patellofemoral arthritis is still a challenge even now. The most important aspect is to differentiate between whether the degeneration is caused by simple local trauma or by an ongoing overload or malalignment. Therefore, differential diagnostics concerning the localization and the etiology have to be performed. In comparison to generalized arthritis, isolated patellofemoral arthritis can develop in a different way and compared to other regions of the knee joint, patellofemoral degeneration has a non-traumatic origin in most cases. Therefore, the various forms of chondral treatment used successfully in other joint compartments show different outcomes for the patellofemoral joint. As no studies have been published which investigated the treatment of cartilaginous defects in correlation to the pathomorphology or investigated combined techniques, a gold standard for the simultaneous treatment of focal arthritis and its causes has not yet been found. However, to achieve satisfying results it is necessary to treat not only the cartilaginous or osteochondral defects but also the underlying pathomorphology. Therefore, even in young patients with severe patellofemoral degeneration due to trochlear dysplasia with permanent patellar dislocation and increased pressure, it would be justified to implant a patellofemoral prosthesis as hereditary dysplasia of the trochlea can be rectified and instability would be corrected as well as the degeneration. The optimal treatment depends on the circumference and localization of the cartilaginous defect. Except for direct defects of the cartilage caused by trauma, an additional intervention to treat the underlying factor has to be considered to adjust the alignment and tracking of the patellofemoral joint and therefore to lower the non-physiological pressure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Davies AP, Vince AS, Shepstone L et al (2002) The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop 402:206–212

    Article  PubMed  Google Scholar 

  2. Utting MR, Davies G, Newman JH (2005) Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee 5(12):362–365

    Article  Google Scholar 

  3. Oberlander MA, Baker CL, Morgan BE (1998) Patellofemoral arthrosis: the treatment options. Am J Orthop 4(27):263–270

    Google Scholar 

  4. Minkowitz RB, Bosco JA 3rd (2009) Patellofemoral arthritis. Bull NYU Hosp Jt Dis 1(67):30–38

    Google Scholar 

  5. Dye SF (2005) The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 436:100–110

    Article  PubMed  Google Scholar 

  6. Schöttle PB, Hensler D (2009) Therapie der patellofemoralen Arthrose. Arthroskopie 3(22):205–216

    Article  Google Scholar 

  7. Argenson JN, Guillaume JM, Aubaniac JM (1995) Is there a place for patellofemoral arthroplasty? Clin Orthop Relat Res 321:162–167

    PubMed  Google Scholar 

  8. Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 1(16):29–36

    Article  Google Scholar 

  9. Maenpaa H, Lehto MU (1997) Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res 339:156–162

    Article  PubMed  Google Scholar 

  10. Smith JS (2001) Osteochondritis dissecans of the patellofemoral joint. Am J Sports Med 1(29):112–113

    Google Scholar 

  11. McAlindon T, Zhang Y, Hannan M et al (1996) Are risk factors for patellofemoral and tibiofemoral knee osteoarthritis different? J Rheumatol 2(23):332–337

    Google Scholar 

  12. Grelsamer RP, Dejour D, Gould J (2008) The pathophysiology of patellofemoral arthritis. Orthop Clin North Am 3(39):269–274 (v)

    Article  Google Scholar 

  13. Reilly DT, Martens M (1972) Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand 2(43):126–137

    Google Scholar 

  14. Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197

    PubMed  Google Scholar 

  15. Eckstein F, Putz R, Muller-Gerbl M et al (1993) Cartilage degeneration in the human patellae and its relationship to the mineralisation of the underlying bone: a key to the understanding of chondromalacia patellae and femoropatellar arthrosis? Surg Radiol Anat 4(15):279–286

    Article  Google Scholar 

  16. Merchant AC, Mercer RL (1974) Lateral release of the patella. A preliminary report. Clin Orthop Relat Res 103:40–45

    Article  PubMed  Google Scholar 

  17. Hinterwimmer S, Gotthardt M, Eisenhart-Rothe R von et al (2005) In vivo contact areas of the knee in patients with patellar subluxation. J Biomech 10(38):2095–2101

    Article  Google Scholar 

  18. Strobel M, Weiler A (2001) Pitfalls and pearls for the management of the posterior cruciate ligament deficient knee. Tech Orthop (16):167–194

    Google Scholar 

  19. Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 308:18–28

    PubMed  Google Scholar 

  20. Goutallier D, Bernageau J, Lecudonnec B (1978) Mesure de l’écart tubérosité tibiale antérieure – gorge de la trochlée (TA-GT). Rev Chir Orthop Reparatrice Appar Mot 5(64):423–428

    Google Scholar 

  21. Fithian DC, Paxton EW, Post WR, Panni AS (2004) Lateral retinacular release: a survey of the International Patellofemoral Study Group. Arthroscopy 5(20):463–468

    Google Scholar 

  22. Ostermeier S, Holst M, Hurschler C et al (2007) Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study. Knee Surg Sports Traumatol Arthrosc 5(15):547–554

    Article  Google Scholar 

  23. Paulos LE, O’Connor DL, Karistinos A (2008) Partial lateral patellar facetectomy for treatment of arthritis due to lateral patellar compression syndrome. Arthroscopy 5(24):547–553

    Google Scholar 

  24. Lattermann C, Drake GN, Spellman J, Bach BR Jr (2006) Lateral retinacular release for anterior knee pain: a systematic review of the literature. J Knee Surg 4(19):278–284

    Google Scholar 

  25. Ostermeier S, Becher C (2010) Einfluss des Tuberositastransfers auf das patellofemorale Gelenk. Arthoskopie 23:208–214

    Article  Google Scholar 

  26. Kuroda R, Kambic H, Valdevit A, Andrish JT (2001) Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study. Am J Sports Med 4(29):403–409

    Google Scholar 

  27. Steinwachs MR, Kreuz PC, Guhlke-Steinwachs U, Niemeyer P (2008) Current treatment for cartilage damage in the patellofemoral joint. Orthopade 9(37):841–847

    Google Scholar 

  28. Kreuz PC, Erggelet C, Steinwachs MR et al (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 11(22):1180–1186

    Google Scholar 

  29. Imhoff AB, Ottl GM, Burkart A, Traub S (1999) Autologous osteochondral transplantation on various joints. Orthopade 1(28):33–44

    Google Scholar 

  30. Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: 10 years of experimental and clinical experience. J Bone Joint Surg Am 85-A(Suppl 2):25–32

  31. Nho SJ, Foo LF, Green DM et al (2008) Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med 6(36):1101–1109

    Article  Google Scholar 

  32. Henderson IJ, Lavigne P (2006) Periosteal autologous chondrocyte implantation for patellar chondral defect in patients with normal and abnormal patellar tracking. Knee 4(13):274–279

    Article  Google Scholar 

  33. Krajca-Radcliffe JB, Coker TP (1996) Patellofemoral arthroplasty. A 2- to 18-year follow up study. Clin Orthop Relat Res 330:143–151

    Article  PubMed  Google Scholar 

  34. Mertl P, Van FT, Bonhomme P, Vives P (1997) Femoropatellar osteoarthritis treated by prosthesis. Retrospective study of 50 implants. Rev Chir Orthop Reparatrice Appar Mot 8(83):712–718

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P.B. Schöttle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schöttle, P., Ostermeier, S. Die patellofemorale Arthrose. Arthroskopie 25, 204–214 (2012). https://doi.org/10.1007/s00142-012-0699-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00142-012-0699-7

Schlüsselwörter

Keywords

Navigation