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Knochenmarködeme und Osteonekrosen nach Meniskektomie

Bone marrow edema and osteonecrosis after meniscectomy

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Knochenmarködeme und Osteonekrosen sind mögliche Folgen einer Meniskektomie. Das MRT ist eine sehr spezifische Methode, um die Veränderungen frühzeitig darzustellen. Hier sind die fettsupprimierten T2-Aufnahmen am besten geeignet. Bei der differenzialdiagnostischen Überlegung müssen Knochenmarködeme ohne Nekrosezeichen von denen mit Nekrosezeichen unterschieden werden. In der Ätiologie werden der Meniskusriss selbst, die veränderte Kraftübertragung nach Meniskektomie, eine additive Chondromalazie, thermische Schädigung, die Arthroskopie selbst und eine vorbestehende spontane Osteonekrose des Kniegelenks (SONK) diskutiert. Die Osteonekrose des postoperativen Kniegelenks (ONPK) ist eine sehr seltene aber schwerwiegende Komplikation. Ob sie ursächlich auf die Operation zurückzuführen ist, bleibt unklar. Die vorbestehende SONK, die aufgrund eines zu kurzen Zeitfensters (<6 Wochen) im MRT nicht diagnostiziert wurde, ist hier die einzige Differenzialdiagnose. Diese beiden Krankheitsbilder sollten dem Arthroskopeur bekannt sein, um auch wegen der forensischen Bedeutung eine Argumentationskette an der Hand zu haben.

Abstract

Bone marrow edema and osteonecrosis are possible consequences following a meniscectomy. Magnetic resonance imaging (MRI) is a specific method to depict these changes at an early stage and in this case, fat-saturated T2 images are the most suitable. For diagnosis it is important to differentiate between bone marrow edema with and without signs of osteonecrosis. Etiological factors currently being discussed include the meniscus rupture itself, changes in the transmission of loads following meniscectomy, additive cartilage damage, thermal damage, the arthroscopic procedure itself, or preexisting spontaneous osteonecrosis of the knee joint (SONK). Osteonecrosis of the postoperative knee joint (ONPK) is an exceedingly rare but serious complication. Whether or not this can be attributed to the surgical procedure remains unclear. Preexisting SONK which is not diagnosed by MRI due to an inadequate time frame (<6 weeks) is the only differential diagnosis. Due to the forensic importance, arthroscopic surgeons should be well acquainted with both clinical pictures in order to have a line of reasoning at hand.

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Literatur

  1. Aglietti P, Insall JN, Buzzi R, Deschamps G (1983) Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg [Br] 65(5):588–597

    Google Scholar 

  2. Ahlbäck S, Bauer GC, Bohne WH (1968) Spontaneous osteonecrosis of the knee. Arthritis Rheum 11(6):705–733

    Article  PubMed  Google Scholar 

  3. Akgun RC, Tandogan NR, Karaman A et al (2007) Development of osteonecrosis after arthroscopic meniscal and chondral knee surgery: a report of five cases. Acta Orthop Traumatol Turc 41(1):80–88

    PubMed  Google Scholar 

  4. al-Kaar M, Garcia J, Fritschy D, Bonvin JC (1997) Aseptic osteonecrosis of the femoral condyle after meniscectomy by the arthroscopic approach. J Radiol 78(4):283–288

    CAS  PubMed  Google Scholar 

  5. Allum R (2003) Complications of arthroscopic reconstruction of the anterior cruciate ligament. J Bone Joint Surg [Br] 85(1):12–16

    Google Scholar 

  6. Athanasian EA, Wickiewicz TL, Warren RF (1995) Osteonecrosis of the femoral condyle after arthroscopic reconstruction of a cruciate ligament. Report of two cases. J Bone Joint Surg [Am] 77(9):1418–1422

    Google Scholar 

  7. Bonutti PM, Seyler TM, Delanois RE et al (2006) Osteonecrosis of the knee after laser or radiofrequency-assisted arthroscopy: treatment with minimally invasive knee arthroplasty. J Bone Joint Surg [Am] 88(suppl 3):69–75

    Google Scholar 

  8. Brahme SK, Fox JM, Ferkel RD et al (1991) Osteonecrosis of the knee after arthroscopic surgery: diagnosis with MR imaging. Radiology 178(3):851–853

    CAS  PubMed  Google Scholar 

  9. Breitenseher MJ, Kramer J, Mayerhoefer ME et al (2006) Differential diagnosis of bone marrow edema of the knee joint. Radiologe 46(1):46–54

    Article  CAS  PubMed  Google Scholar 

  10. Cetik O, Cift H, Comert B, Cirpar M (2009) Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series. Knee Surg Sports Traumatol Arthrosc 17(1):24–29

    Article  PubMed  Google Scholar 

  11. DeFalco RA, Ricci AR, Balduini FC (2003) Osteonecrosis of the knee after arthroscopic meniscectomy and chondroplasty: a case report and literature review. Am J Sports Med 31(6):1013–1016

    PubMed  Google Scholar 

  12. Duc SR, Koch P, Schmid MR et al (2007) Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence. Radiology 243(2):475–482

    Article  PubMed  Google Scholar 

  13. Faletti C, Robba T, de Petro P (2002) Postmeniscectomy osteonecrosis. Arthroscopy 18(1):91–94

    Article  PubMed  Google Scholar 

  14. Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg [Br] 67(1):3–9

    Google Scholar 

  15. Fink B, Schneider T, Braunstein S et al (1996) YAG laser-induced aseptic bone necroses of the femoral condyle. Arthroscopy 12(2):217–223

    Article  CAS  PubMed  Google Scholar 

  16. Fukuda Y, Takai S, Yoshino N et al (2000) Impact load transmission of the knee joint-influence of leg alignment and the role of meniscus and articular cartilage. Clin Biomech (Bristol, Avon) 15(7):516–521

    Google Scholar 

  17. Hofmann S, Kramer J, Breitenseher M et al (2006) Bone marrow edema in the knee. Differential diagnosis and therapeutic possibilities. Orthopade 35(4):463–475

    Article  CAS  PubMed  Google Scholar 

  18. Hofmann S, Kramer J, Vakil-Adli A et al (2004) Painful bone marrow edema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin North Am 35(3):321–333, ix

    Article  PubMed  Google Scholar 

  19. Johnson TC, Evans JA, Gilley JA, DeLee JC (2000) Osteonecrosis of the knee after arthroscopic surgery for meniscal tears and chondral lesions. Arthroscopy 16(3):254–261

    Article  CAS  PubMed  Google Scholar 

  20. Kattapuram TM, Kattapuram SV (2008) Spontaneous osteonecrosis of the knee. Eur J Radiol 67(1):42–48

    Article  PubMed  Google Scholar 

  21. Kobayashi Y, Kimura M, Higuchi H et al (2002) Juxta-articular bone marrow signal changes on magnetic resonance imaging following arthroscopic meniscectomy. Arthroscopy 18(3):238–245

    Article  PubMed  Google Scholar 

  22. Kornaat PR, Kloppenburg M, Sharma R et al (2007) Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features. Eur Radiol 17(12):3073–3078

    Article  PubMed  Google Scholar 

  23. Kusayama T (2003) Idiopathic osteonecrosis of the femoral condyle after meniscectomy. Tokai J Exp Clin Med 28(4):145–150

    PubMed  Google Scholar 

  24. Lecouvet FE, Malghem J, Maldague BE, Vande Berg BC (2005) MR imaging of epiphyseal lesions of the knee: current concepts, challenges, and controversies. Radiol Clin North Am 43(4):655-viii

    Article  PubMed  Google Scholar 

  25. Link TM, Steinbach LS, Ghosh S et al (2003) Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 226(2):373–381

    Article  PubMed  Google Scholar 

  26. MacDessi SJ, Brophy RH, Bullough PG et al (2008) Subchondral fracture following arthroscopic knee surgery. A series of eight cases. J Bone Joint Surg [Am] 90(5):1007–1012

    Google Scholar 

  27. Mayerhoefer ME, Breitenseher MJ, Kramer J et al (2005) STIR vs. T1-weighted fat-suppressed gadolinium-enhanced MRI of bone marrow edema of the knee: computer-assisted quantitative comparison and influence of injected contrast media volume and acquisition parameters. J Magn Reson Imaging 22(6):788–793

    Article  PubMed  Google Scholar 

  28. Mont MA, Baumgarten KM, Rifai A et al (2000) Atraumatic osteonecrosis of the knee. J Bone Joint Surg [Am] 82(9):1279–1290

    Google Scholar 

  29. Mont MA, Ulrich SD, Seyler TM et al (2008) Bone scanning of limited value for diagnosis of symptomatic oligofocal and multifocal osteonecrosis. J Rheumatol 35(8):1629–1634

    PubMed  Google Scholar 

  30. Motohashi M, Morii T, Koshino T (1991) Clinical course and roentgenographic changes of osteonecrosis in the femoral condyle under conservative treatment. Clin Orthop Relat Res 266:156–161

    PubMed  Google Scholar 

  31. Muscolo DL, Costa-Paz M, Ayerza M, Makino A (2006) Medial meniscal tears and spontaneous osteonecrosis of the knee. Arthroscopy 22(4):457–460

    Article  PubMed  Google Scholar 

  32. Nakamura N, Horibe S, Nakamura S, Mitsuoka T (2002) Subchondral microfracture of the knee without osteonecrosis after arthroscopic medial meniscectomy. Arthroscopy 18(5):538–541

    Article  PubMed  Google Scholar 

  33. Narvaez JA, Narvaez J, De Lama E, Sanchez A (2003) Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Eur Radiol 13(8):1843–1848

    Article  CAS  PubMed  Google Scholar 

  34. Norman A, Baker ND (1978) Spontaneous osteonecrosis of the knee and medial meniscal tears. Radiology 129(3):653–656

    CAS  PubMed  Google Scholar 

  35. Pape D, Lorbach O, Anagnostakos K, Kohn D (2008) Osteonecrosis in the postarthroscopic knee. Orthopade 37(11):1099–1107

    Article  CAS  PubMed  Google Scholar 

  36. Pape D, Seil R, Anagnostakos K, Kohn D (2007) Postarthroscopic osteonecrosis of the knee. Arthroscopy 23(4):428–438

    Article  PubMed  Google Scholar 

  37. Peterfy CG, Gold G, Eckstein F et al (2006) MRI protocols for whole-organ assessment of the knee in osteoarthritis. Osteoarthritis Cartil 14(suppl A):A95–A111

    Article  Google Scholar 

  38. Plenk H Jr, Hofmann S, Eschberger J et al (1997) Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res 334:73–84

    Article  PubMed  Google Scholar 

  39. Pollack MS, Dalinka MK, Kressel HY et al (1987) Magnetic resonance imaging in the evaluation of suspected osteonecrosis of the knee. Skeletal Radiol 16(2):121–127

    Article  CAS  PubMed  Google Scholar 

  40. Prues-Latour V, Bonvin JC, Fritschy D (1998) Nine cases of osteonecrosis in elderly patients following arthroscopic meniscectomy. Knee Surg Sports Traumatol Arthrosc 6(3):142–147

    Article  CAS  PubMed  Google Scholar 

  41. Robertson DD, Armfield DR, Towers JD et al (2009) Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg [Br] 91(2):190–195

    Google Scholar 

  42. Roemer FW, Frobell R, Hunter DJ et al (2009) MRI-detected subchondral bone marrow signal alterations of the knee joint: terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthritis Cartil 17(9):1115–1131

    Article  CAS  Google Scholar 

  43. Santori N, Condello V, Adriani E, Mariani PP (1995) Osteonecrosis after arthroscopic medial meniscectomy. Arthroscopy 11(2):220–224

    Article  CAS  PubMed  Google Scholar 

  44. Seitz S, Godolias G (2003) Osteonekrose des Femurkondylus nach Arthroskopie – eine Komplikation des Eingriffs? Arthroskopie 16(1):44–50

    Article  Google Scholar 

  45. Wilson AJ, Murphy WA, Hardy DC, Totty WG (1988) Transient osteoporosis: transient bone marrow edema? Radiology 167(3):757–760

    CAS  PubMed  Google Scholar 

  46. Yamamoto T, Bullough PG (2000) Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg [Am] 82(6):858–866

    Google Scholar 

  47. Yoshioka H, Stevens K, Hargreaves BA et al (2004) Magnetic resonance imaging of articular cartilage of the knee: comparison between fat-suppressed three-dimensional SPGR imaging, fat-suppressed FSE imaging, and fat-suppressed three-dimensional DEFT imaging, and correlation with arthroscopy. J Magn Reson Imaging 20(5):857–864

    Article  PubMed  Google Scholar 

  48. Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215(3):835–840

    CAS  PubMed  Google Scholar 

  49. Zywiel MG, McGrath MS, Seyler TM et al (2009) Osteonecrosis of the knee: a review of three disorders. Orthop Clin North Am 40(2):193–211

    Article  PubMed  Google Scholar 

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  1. Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland

    F. Mauch M.A. & G. Bauer

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Mauch, F., Bauer, G. Knochenmarködeme und Osteonekrosen nach Meniskektomie. Arthroskopie 24, 6–14 (2011). https://doi.org/10.1007/s00142-010-0591-2

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