Skip to main content
Erschienen in: Orthopädie & Rheuma 2/2018

16.04.2018 | Magnetresonanztomografie | Zertifizierte Fortbildung

Harmloser Zufallsbefund oder therapiebedürftige Erkrankung?

Das Knochenmarködem am Kniegelenk: eine diagnostische Herausforderung

verfasst von: Univ.-Prof. Dr. med. Marcus Jäger, Florian Dittrich, Katharina Harren

Erschienen in: Orthopädie & Rheuma | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das Knochenmarködem (KMÖ) am Kniegelenk ist ein relativ häufiger Befund in der Magnetresonanztomografie (MRT). Pathophysiologisch liegt dem KMÖ eine gestörte vaskuläre Perfusion mit einer intraossären Druckerhöhung zugrunde. Häufig wird das KMÖ von Schmerzen begleitet, jedoch auch als Zufallsbefund bei asymptomatischen Patienten beobachtet. Als unspezifische, bildmorphologische Erscheinung ist die Abgrenzung zwischen einem spontan reversiblen Knochenmarködemsyndrom, entzündlichen Prozessen, dem Frühstadium der avaskulären Osteonekrose oder einer zugrunde liegenden Knorpelschädigungen schwierig. Nicht zuletzt aufgrund der unterschiedlichen Therapie ist die differenzialdiagnostische Einschätzung des kniegelenknahen KMÖ eine klinische Herausforderung.
Literatur
1.
Zurück zum Zitat Curtiss Jr, P.H. and W.E. Kincaid, Transitory demineralization of the hip in pregnancy: a report of three cases. JBJS, 1959. 41(7): p. 1327–1333.CrossRef Curtiss Jr, P.H. and W.E. Kincaid, Transitory demineralization of the hip in pregnancy: a report of three cases. JBJS, 1959. 41(7): p. 1327–1333.CrossRef
2.
Zurück zum Zitat Adam, G., et al. MR-Tomographie avaskulärer Knochennekrosen: Primärbefunde und Verlaufsbeobachtungen nach Markraumdekompression. in RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 1995. © Georg Thieme Verlag Stuttgart• New York. Adam, G., et al. MR-Tomographie avaskulärer Knochennekrosen: Primärbefunde und Verlaufsbeobachtungen nach Markraumdekompression. in RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 1995. © Georg Thieme Verlag Stuttgart• New York.
3.
Zurück zum Zitat Karantanas, A.H. and E.E. Drakonaki. The role of MR imaging in avascular necrosis of the femoral head. in Seminars in musculoskeletal radiology. 2011. © Thieme Medical Publishers. Karantanas, A.H. and E.E. Drakonaki. The role of MR imaging in avascular necrosis of the femoral head. in Seminars in musculoskeletal radiology. 2011. © Thieme Medical Publishers.
4.
Zurück zum Zitat Orth, P. and K. Anagnostakos, Coagulation abnormalities in osteonecrosis and bone marrow edema syndrome. Orthopedics, 2013. 36(4): p. 290–300.CrossRef Orth, P. and K. Anagnostakos, Coagulation abnormalities in osteonecrosis and bone marrow edema syndrome. Orthopedics, 2013. 36(4): p. 290–300.CrossRef
5.
Zurück zum Zitat Claßen, T., et al., Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis. Orthopedic reviews, 2016. 8(1). Claßen, T., et al., Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis. Orthopedic reviews, 2016. 8(1).
6.
Zurück zum Zitat Marcacci, M., et al., Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Reviews, 2016. 1(5): p. 219–224.CrossRef Marcacci, M., et al., Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Reviews, 2016. 1(5): p. 219–224.CrossRef
7.
Zurück zum Zitat Berman, N., et al., Transient osteoporosis: Not just the hip to worry about. Bone reports, 2016. 5: p. 308–311.CrossRef Berman, N., et al., Transient osteoporosis: Not just the hip to worry about. Bone reports, 2016. 5: p. 308–311.CrossRef
8.
Zurück zum Zitat Geith, T., et al., Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation. Radiology, 2016. 283(2): p. 478–485.CrossRef Geith, T., et al., Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation. Radiology, 2016. 283(2): p. 478–485.CrossRef
9.
Zurück zum Zitat Kon, E., et al., Bone marrow lesions and subchondral bone pathology of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 2016. 24(6): p. 1797–1814.CrossRef Kon, E., et al., Bone marrow lesions and subchondral bone pathology of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 2016. 24(6): p. 1797–1814.CrossRef
10.
Zurück zum Zitat Seamon, J., et al., The pathogenesis of nontraumatic osteonecrosis. Arthritis, 2012. 2012.CrossRef Seamon, J., et al., The pathogenesis of nontraumatic osteonecrosis. Arthritis, 2012. 2012.CrossRef
11.
Zurück zum Zitat Drescher, W., et al., Femoral head blood flow reduction and hypercoagulability under 24 h megadose steroid treatment in pigs. Journal of Orthopaedic Research, 2004. 22(3): p. 501–508.CrossRef Drescher, W., et al., Femoral head blood flow reduction and hypercoagulability under 24 h megadose steroid treatment in pigs. Journal of Orthopaedic Research, 2004. 22(3): p. 501–508.CrossRef
12.
Zurück zum Zitat Inoue, S., et al., Risk factors for nontraumatic osteonecrosis of the femoral head afterrenal transplantation. Journal of orthopaedic science, 2003. 8(6): p. 751–756.CrossRef Inoue, S., et al., Risk factors for nontraumatic osteonecrosis of the femoral head afterrenal transplantation. Journal of orthopaedic science, 2003. 8(6): p. 751–756.CrossRef
13.
Zurück zum Zitat Jones, L.C., et al., Procoagulants and osteonecrosis. The Journal of rheumatology, 2003. 30(4): p. 783–791.PubMed Jones, L.C., et al., Procoagulants and osteonecrosis. The Journal of rheumatology, 2003. 30(4): p. 783–791.PubMed
14.
Zurück zum Zitat Simank, H.-G., et al., Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. International orthopaedics, 1999. 23(3): p. 154–159.CrossRef Simank, H.-G., et al., Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. International orthopaedics, 1999. 23(3): p. 154–159.CrossRef
15.
Zurück zum Zitat Kemper, O., et al., Prostacyclin suppresses twist expression in the presence of indomethacin in bone marrow-derived mesenchymal stromal cells. Medical science monitor: international medical journal of experimental and clinical research, 2014. 20: p. 2219.CrossRef Kemper, O., et al., Prostacyclin suppresses twist expression in the presence of indomethacin in bone marrow-derived mesenchymal stromal cells. Medical science monitor: international medical journal of experimental and clinical research, 2014. 20: p. 2219.CrossRef
16.
Zurück zum Zitat Banaszkiewicz, P.A., Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment, in Classic Papers in Orthopaedics. 2014, Springer. p. 121-123. Banaszkiewicz, P.A., Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment, in Classic Papers in Orthopaedics. 2014, Springer. p. 121-123.
17.
Zurück zum Zitat Plenk Jr, H., et al., Pathomorphologische Aspekte und Reparaturmechanismen der Femurkopfosteonekrose. Der Orthopäde, 2000. 29(5): p. 389–402.PubMed Plenk Jr, H., et al., Pathomorphologische Aspekte und Reparaturmechanismen der Femurkopfosteonekrose. Der Orthopäde, 2000. 29(5): p. 389–402.PubMed
18.
Zurück zum Zitat Budzik, J.-F., et al., Perfusion of subchondral bone marrow in knee osteoarthritis: A dynamic contrast-enhanced magnetic resonance imaging preliminary study. European Journal of Radiology, 2017. 88: p. 129–134.CrossRef Budzik, J.-F., et al., Perfusion of subchondral bone marrow in knee osteoarthritis: A dynamic contrast-enhanced magnetic resonance imaging preliminary study. European Journal of Radiology, 2017. 88: p. 129–134.CrossRef
19.
Zurück zum Zitat Viskontas, D.G., et al., Bone bruises associated with ACL rupture: correlation with injury mechanism. The American journal of sports medicine, 2008. 36(5): p. 927–933.CrossRef Viskontas, D.G., et al., Bone bruises associated with ACL rupture: correlation with injury mechanism. The American journal of sports medicine, 2008. 36(5): p. 927–933.CrossRef
20.
Zurück zum Zitat Vellet, A.D., et al., Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology, 1991. 178(1): p. 271–276.CrossRef Vellet, A.D., et al., Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology, 1991. 178(1): p. 271–276.CrossRef
21.
Zurück zum Zitat Takahashi, T., et al., MR appearance of autologous chondrocyte implantation in the knee: correlation with the knee features and clinical outcome. Skeletal radiology, 2006. 35(1): p. 16–26.CrossRef Takahashi, T., et al., MR appearance of autologous chondrocyte implantation in the knee: correlation with the knee features and clinical outcome. Skeletal radiology, 2006. 35(1): p. 16–26.CrossRef
22.
Zurück zum Zitat Harper, P.G., C. Trask, and R.L. Souhami, Avascular necrosis of bone caused by combination chemotherapy without corticosteroids. Br Med J (Clin Res Ed), 1984. 288(6413): p. 267–268.CrossRef Harper, P.G., C. Trask, and R.L. Souhami, Avascular necrosis of bone caused by combination chemotherapy without corticosteroids. Br Med J (Clin Res Ed), 1984. 288(6413): p. 267–268.CrossRef
23.
Zurück zum Zitat Filardo, G., et al., Is the clinical outcome after cartilage treatment affected by subchondral bone edema? Knee Surgery, Sports Traumatology, Arthroscopy, 2014. 22(6): p. 1337–1344.CrossRef Filardo, G., et al., Is the clinical outcome after cartilage treatment affected by subchondral bone edema? Knee Surgery, Sports Traumatology, Arthroscopy, 2014. 22(6): p. 1337–1344.CrossRef
24.
Zurück zum Zitat Roemer, F.W., et al., Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST Study. A longitudinal multicentre study of knee osteoarthritis. Annals of the rheumatic diseases, 2009. 68(9): p. 1461–1465.CrossRef Roemer, F.W., et al., Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST Study. A longitudinal multicentre study of knee osteoarthritis. Annals of the rheumatic diseases, 2009. 68(9): p. 1461–1465.CrossRef
25.
Zurück zum Zitat Scher, C., J. Craig, and F. Nelson, Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up. Skeletal radiology, 2008. 37(7): p. 609–617.CrossRef Scher, C., J. Craig, and F. Nelson, Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up. Skeletal radiology, 2008. 37(7): p. 609–617.CrossRef
26.
Zurück zum Zitat Jäger, M. and R. Krauspe, Osteonekrosen. Pathogenese- Diagnostik- Therapie- Verlauf. UNI- MED, 2007. 1. Jäger, M. and R. Krauspe, Osteonekrosen. Pathogenese- Diagnostik- Therapie- Verlauf. UNI- MED, 2007. 1.
27.
Zurück zum Zitat Strauss, M.B., et al., Reduction of skeletal muscle necrosis using intermittent hyperbaric oxygen in a model compartment syndrome. JBJS, 1983. 65(5): p. 656–662.CrossRef Strauss, M.B., et al., Reduction of skeletal muscle necrosis using intermittent hyperbaric oxygen in a model compartment syndrome. JBJS, 1983. 65(5): p. 656–662.CrossRef
28.
Zurück zum Zitat Hofmann, S. and B. Mazieres, Osteonecrosis: natural course and conservative therapy. Der Orthopade, 2000. 29(5): p. 403–410.PubMed Hofmann, S. and B. Mazieres, Osteonecrosis: natural course and conservative therapy. Der Orthopade, 2000. 29(5): p. 403–410.PubMed
29.
Zurück zum Zitat Boerma, I., Life without blood. A study of the influence of high atmospheric pressure and hyperthermia on dilution of the blood. J. Cardiovasc Surg.(Torino), 1960. 1: p. 133–146. Boerma, I., Life without blood. A study of the influence of high atmospheric pressure and hyperthermia on dilution of the blood. J. Cardiovasc Surg.(Torino), 1960. 1: p. 133–146.
30.
Zurück zum Zitat Bird, A. and A. Telfer, Effect of hyperbaric oxygen on limb circulation. The Lancet, 1965. 285(7381): p. 355–356.CrossRef Bird, A. and A. Telfer, Effect of hyperbaric oxygen on limb circulation. The Lancet, 1965. 285(7381): p. 355–356.CrossRef
31.
Zurück zum Zitat Strauss, M., et al., Femoral head necrosis and hyperbaric oxygen therapy. Hyperbaric medicine practice. Best Publishing Co, 1999. 912. Strauss, M., et al., Femoral head necrosis and hyperbaric oxygen therapy. Hyperbaric medicine practice. Best Publishing Co, 1999. 912.
32.
Zurück zum Zitat Skyhar, M., et al., Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in. J Bone Joint Surg Am, 1986. 68: p. 1218–1224.CrossRef Skyhar, M., et al., Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in. J Bone Joint Surg Am, 1986. 68: p. 1218–1224.CrossRef
33.
Zurück zum Zitat Wolfe, C.J. and K.L. Taylor-Butler, Avascular necrosis: a case history and literature review. Archives of family medicine, 2000. 9(3): p. 291.CrossRef Wolfe, C.J. and K.L. Taylor-Butler, Avascular necrosis: a case history and literature review. Archives of family medicine, 2000. 9(3): p. 291.CrossRef
34.
Zurück zum Zitat Oriani, G., et al., Physiology and physiopathology of hyperbaric oxygen, in Handbook on hyperbaric medicine. 1996, Springer. p. 1-34. Oriani, G., et al., Physiology and physiopathology of hyperbaric oxygen, in Handbook on hyperbaric medicine. 1996, Springer. p. 1-34.
35.
Zurück zum Zitat Glueck, C.J., et al., Thrombophilia and Hypofibrinolysis; Pathophysiologies of Osteonecrosis. Clinical orthopaedics and related research, 1997. 334: p. 43–56.CrossRef Glueck, C.J., et al., Thrombophilia and Hypofibrinolysis; Pathophysiologies of Osteonecrosis. Clinical orthopaedics and related research, 1997. 334: p. 43–56.CrossRef
36.
Zurück zum Zitat Glueck, C.J., et al., Estrogen replacement in a protein S deficient patient leads to diarrhea, hyperglucagonemia, and osteonecrosis. Jop, 2001. 2(5): p. 323–329.PubMed Glueck, C.J., et al., Estrogen replacement in a protein S deficient patient leads to diarrhea, hyperglucagonemia, and osteonecrosis. Jop, 2001. 2(5): p. 323–329.PubMed
37.
Zurück zum Zitat Niethammer, T.R., et al., Bone marrow edema in the knee and its influence on clinical outcome after matrix-based autologous chondrocyte implantation: results after 3-year follow-up. The American journal of sports medicine, 2015. 43(5): p. 1172–1179.CrossRef Niethammer, T.R., et al., Bone marrow edema in the knee and its influence on clinical outcome after matrix-based autologous chondrocyte implantation: results after 3-year follow-up. The American journal of sports medicine, 2015. 43(5): p. 1172–1179.CrossRef
38.
Zurück zum Zitat Leschke, M., W. Klimek, and F. Jung, [Rheological determinants of end-organ damage]. Internist (Berl), 2003. 44(7): p. 853–63.CrossRef Leschke, M., W. Klimek, and F. Jung, [Rheological determinants of end-organ damage]. Internist (Berl), 2003. 44(7): p. 853–63.CrossRef
39.
Zurück zum Zitat Laroche, M., et al., Nifedipine per os relieves the pain caused by osteonecrosis of the femur head. Revue du rhumatisme et des maladies osteo-articulaires, 1990. 57(9): p. 669–670.PubMed Laroche, M., et al., Nifedipine per os relieves the pain caused by osteonecrosis of the femur head. Revue du rhumatisme et des maladies osteo-articulaires, 1990. 57(9): p. 669–670.PubMed
40.
Zurück zum Zitat Arlet, J., et al., The Effect of IV Injection of Naftidrofuryl (Praxilene) on Intramedullary Pressure in Patients with Osteonecrosis of the Femoral Head, in Bone Circulation and Bone Necrosis. 1990, Springer. p. 405-406. Arlet, J., et al., The Effect of IV Injection of Naftidrofuryl (Praxilene) on Intramedullary Pressure in Patients with Osteonecrosis of the Femoral Head, in Bone Circulation and Bone Necrosis. 1990, Springer. p. 405-406.
41.
Zurück zum Zitat Jäger, M., et al., Rationale for prostaglandin I 2 in bone marrow oedema—from theory to application. Arthritis research & therapy, 2008. 10(5): p. R120.CrossRef Jäger, M., et al., Rationale for prostaglandin I 2 in bone marrow oedema—from theory to application. Arthritis research & therapy, 2008. 10(5): p. R120.CrossRef
42.
Zurück zum Zitat Jäger, M., et al., Efficiency of iloprost treatment for osseous malperfusion. International orthopaedics, 2011. 35(5): p. 761–765.CrossRef Jäger, M., et al., Efficiency of iloprost treatment for osseous malperfusion. International orthopaedics, 2011. 35(5): p. 761–765.CrossRef
43.
Zurück zum Zitat Jaeger, M., et al., Efficiency of iloprost treatment for chemotherapy-associated osteonecrosis after childhood cancer. Anticancer research, 2009. 29(8): p. 3433–3440. Jaeger, M., et al., Efficiency of iloprost treatment for chemotherapy-associated osteonecrosis after childhood cancer. Anticancer research, 2009. 29(8): p. 3433–3440.
44.
Zurück zum Zitat Jäger, M., et al., Schmerztherapie bei nichtjuvenilen, aseptischen Osteonekrosen. Der Schmerz, 2004. 18(6): p. 481–491.CrossRef Jäger, M., et al., Schmerztherapie bei nichtjuvenilen, aseptischen Osteonekrosen. Der Schmerz, 2004. 18(6): p. 481–491.CrossRef
45.
Zurück zum Zitat Schermuly, R.T., et al., Antiremodeling effects of iloprost and the dual-selective phosphodiesterase 3/4 inhibitor tolafentrine in chronic experimental pulmonary hypertension. Circulation research, 2004. 94(8): p. 1101–1108.CrossRef Schermuly, R.T., et al., Antiremodeling effects of iloprost and the dual-selective phosphodiesterase 3/4 inhibitor tolafentrine in chronic experimental pulmonary hypertension. Circulation research, 2004. 94(8): p. 1101–1108.CrossRef
46.
Zurück zum Zitat Winet, H., J.Y. Bao, and R. Moffat, A control model for tibial cortex neovascularization in the bone chamber. Journal of Bone and Mineral Research, 1990. 5(1): p. 19–30.CrossRef Winet, H., J.Y. Bao, and R. Moffat, A control model for tibial cortex neovascularization in the bone chamber. Journal of Bone and Mineral Research, 1990. 5(1): p. 19–30.CrossRef
47.
Zurück zum Zitat Izbicka, E., et al., Human amniotic tumor that induces new bone formation in vivo produces a growth-regulatory activity in vitro for osteoblasts identified as an extended form of basic fibroblast growth factor. Cancer research, 1996. 56(3): p. 633–636.PubMed Izbicka, E., et al., Human amniotic tumor that induces new bone formation in vivo produces a growth-regulatory activity in vitro for osteoblasts identified as an extended form of basic fibroblast growth factor. Cancer research, 1996. 56(3): p. 633–636.PubMed
48.
Zurück zum Zitat Mazieres, B., Bone morphogenetic protein and bone necrosis: a perspective. Arco News, 1994. 6: p. 3–5. Mazieres, B., Bone morphogenetic protein and bone necrosis: a perspective. Arco News, 1994. 6: p. 3–5.
49.
Zurück zum Zitat Scully, S., et al., Augmentation of subchondral bone formation in AVN with rhBMP-2. Scully, S., et al., Augmentation of subchondral bone formation in AVN with rhBMP-2.
Metadaten
Titel
Harmloser Zufallsbefund oder therapiebedürftige Erkrankung?
Das Knochenmarködem am Kniegelenk: eine diagnostische Herausforderung
verfasst von
Univ.-Prof. Dr. med. Marcus Jäger
Florian Dittrich
Katharina Harren
Publikationsdatum
16.04.2018
Verlag
Springer Medizin
Erschienen in
Orthopädie & Rheuma / Ausgabe 2/2018
Print ISSN: 1435-0017
Elektronische ISSN: 2196-5684
DOI
https://doi.org/10.1007/s15002-018-1272-1

Weitere Artikel der Ausgabe 2/2018

Orthopädie & Rheuma 2/2018 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.