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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.

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Authors and Affiliations

  1. Gelenkzentrum Zürich, Toblerstr. 51, 8044, Zürich, Schweiz

    P.B. Schöttle

  2. Gelenk-Klinik, Gundelfingen, Deutschland

    S. Ostermeier

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  1. P.B. Schöttle
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  2. S. Ostermeier
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Correspondence to P.B. Schöttle.

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

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

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