Eigenschaften fokaler degenerativer Knorpelschäden am Kniegelenk. Eine radiologische, spektroskopische histologische und biochemische Untersuchung

Zusammenfassung

Zielstellung: Ziel dieser Untersuchung war es, die Defektränder von Knorpelschäden Grad IIIb der Patella und des medialen Femurkondyls, die korrespondierende Gelenkfläche und die übrigen Knorpelflächen des Kniegelenks makroskopisch, spektroskopisch und biochemisch-histologisch zu untersuchen. Dabei wurde als Nullhypothese angenommen, dass die Eigenschaften des den Defekt umgebenden Knorpels aber auch die korrespondierende Gelenkfläche und die übrigen Gelenkflächen des Kniegelenks keine Unterschiede zum Knorpel innerhalb des Defektes aufweisen

Methode: Bei 10 Patienten, bei denen fokale Knorpelschäden (Grad III b der ICRS- Klassifikation) durch autologe Knorpeltransplantation (ACT) behandelt wurden, wurden in die Studie aufgenommen. Präoperativ wurde bei allen Patienten eine Kernspintomografie (1, 5 T) durchgeführt. Die Klassifikation der Knorpelschäden im Gelenk erfolgte entsprechend den Empfehlungen der International Cartilage Repair Society (ICRS). Während der Arthroskopie wurden im Defekt selbst, im Bereich der Defektränder und an weiteren, insgesamt 14 definierten Arealen spektroskopische Untersuchungen zur Bestimmung des Degenerationsgrades des Knorpels durchgeführt. Biopsien für die Histologie und biochemische Untersuchung (Collagen II, Glycosaminoglycan, DNA) wurden aus dem Defektzentrum sowie den makroskopisch intakten erscheinenden Defekträndern entnommen.

Ergebnisse: In allen Kniegelenken fanden sich sogenannte fokale Knorpelschäden Grad III b mit intaktem Rand und intakter korrespondierende Gelenkfläche. Bei der spektroskopische Untersuchung wurden sowohl im Defekt, in den intakten erscheinenden Rändern, der korrespondierenden Gelenkfläche und allen anderen untersuchten Arealen des Knies Messwerte ermittelt, die Hinweis auf eine bereits eingetretene schwere degenerativer Veränderung im Knorpel gaben. Auch in der histologischen und biochemischen Untersuchung des Restknorpels im Defektzentrum und an den intakten erscheinenden Rändern fanden sich keine signifikanten Unterschiede.

Schlussfolgerungen: Fokale Knorpelschäden kommen sehr häufig in den Hauptbelastungszonen der Patella und des medialen Femurkondyls vor. Soweit diese Folge degenerativer Veränderungen im Kniegelenk sind, unterscheidet sich der Restknorpel im Defekt nicht von dem der Defektränder, der korrespondierenden Gelenkfläche und der anderen Knorpelflächen. Daraus kann geschlussfolgert werden, dass fokale Knorpeldefekte bei degenerativem Gelenkschaden nur ein Teilaspekt einer generellen Gelenkdegeneration sind.

Abstract

Objective: The aim of this study was to perform a macroscopic, spectroscopic and biochemical/histological examination of the defect margins of grade IIIb cartilage lesions in the patella, the medial femoral condyle, the corresponding articular surface and the remaining cartilage surfaces of the knee joint. Our null hypothesis was that there would be no difference in characteristics between the cartilage surrounding the defect, the corresponding articular surface and the remaining articular surfaces of the knee joint on the one hand and the cartilage within the defect on the other.

Method: The study included ten patients treated for focal cartilage lesions (ICRS classification grade IIIb) by autologous cartilage transplantation (ACT). All patients underwent a preoperative magnetic resonance imaging scan (1, 5 T). The articular cartilage lesions were classified pursuant to the recommendations of the International Cartilage Repair Society (ICRS). During the arthroscopic procedure, spectroscopic examinations were performed to measure the degree of cartilage degeneration in a total of 14 defined areas including the defect itself and the region of the defect margins. Biopsies for a histological and biochemical examination (collagen II, glycosaminoglycan, DNA) were taken from the centre of the defect and the defect margins that seemed to be intact on macroscopic examination.

Results: All knee joints had focal grade IIIb cartilage lesions with an intact margin and an intact corresponding articular surface. The readings obtained on spectroscopic examination both in the defect, the apparently intact margins, the corresponding articular surface and all other examined areas of the knee suggested that severe degenerative changes had already occurred in the cartilage. The histological and biochemical examinations of the residual cartilage in the centre of the defect and the apparently intact margins revealed no significant differences.

Conclusions: Focal cartilage lesions frequently occur in the main weight-bearing zones of the patella and the medial femoral condyle. If they are the result of degenerative changes in the knee joint, the residual cartilage in the defect does not differ from the cartilage of the defect margins, the corresponding articular surface and the other cartilage surfaces. This leads to the conclusion that focal cartilage defects seen in degenerative joint damage are only one aspect of general joint degeneration.

Schlüsselwörter

Knorpel - Defekt - ACT - Spektroskopie

Key words

cartilage - defect - ACT - spectroscopy

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