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Knochenmarködem im Kniegelenk

Differenzialdiagnostik und therapeutische Möglichkeiten

Bone marrow edema in the knee

Differential diagnosis and therapeutic possibilities

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Zusammenfassung

Ein Knochenmarködem (KMÖ) ist ein häufiger Befund bei der Abklärung von schmerzhaften Kniegelenken mit der Magnetresonanztomographie (MRT). Sein typisches Signalverhalten ist unspezifisch, und es tritt bei zahlreichen Krankheitsbildern auf. Die Differenzialdiagnose der unterschiedlichen KMÖ des Kniegelenks ist wichtig, da sich daraus verschiedene therapeutische Konsequenzen ergeben. In dieser Übersichtsarbeit werden die schmerzhaften KMÖ ätiologisch in 3 Gruppen unterteilt: Gruppe 1: ischämische KMÖ: Osteonekrose, Osteochondrosis dissecans, Knochenmarködemsyndrom und „complex regional pain syndrome“, Gruppe 2: mechanische KMÖ: Knochenmarkkontusion und Mikrofraktur sowie Stress-KMÖ und Stressfraktur, Gruppe 3: reaktive KMÖ: Gonarthritis, Gonarthrose, postoperativ und Tumoren. Die typische MRT-Morphologie und die Differenzialdiagnosen dieser unterschiedlichen KMÖ-Erscheinungsbilder werden besprochen und die sich daraus ergebenden therapeutischen Konsequenzen kurz dargestellt.

Abstract

The Bone marrow edema (BME) is a common finding when evaluating patients with knee pain by magnetic resonance imaging (MRI). The typical signal patterns of BME are unspecific and can be found with different diseases of the knee. Since different therapeutic approaches are mandatory, differential diagnosis of the several forms of BME is important. In this review, painful BME will be separated into three different etiological groups. Group 1 ischemic BME: osteonecrosis, osteochondritis dissecans, bone marrow edema syndrome and complex regional pain syndrome. Group 2 mechanical BME: bone bruises, microfracture, stress-BME und stress fracture. Group 3 reactive BME: inflammatory gonarthritis, degenerative gonarthrosis, postoperative and tumours. The typical MRI morphologies and differential diagnosis of these BME manifestations will be described. The different therapeutic consequences will also be briefly mentioned.

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Der korrespondierende Autor ist als Berater für klinische Studien für die Firma Schering tätig.

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Authors and Affiliations

  1. Department III, Endoprothetik, Allgemeines und Orthopädisches LKH Stolzalpe, 8852 , Stolzalpe, Österreich

    S. Hofmann

  2. Institut für MR- und CT-Diagnostik am Schillerpark, Linz, Österreich

    J. Kramer

  3. Institut für Radiologie, Waldviertelklinikum , Horn, Österreich

    M. Breitenseher

  4. Allgemeines und Orthopädisches LKH , Stolzalpe, Österreich

    M. Pietsch

  5. Orthopädisches Spital Speising, Wien, Österreich

    N. Aigner

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  1. S. Hofmann
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  2. J. Kramer
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  3. M. Breitenseher
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  4. M. Pietsch
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  5. N. Aigner
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Correspondence to S. Hofmann.

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Hofmann, S., Kramer, J., Breitenseher, M. et al. Knochenmarködem im Kniegelenk. Orthopäde 35, 463–477 (2006). https://doi.org/10.1007/s00132-006-0952-8

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