Spontana osteonekroza koljena (SONK)

Scientific paper - Review paper

• Title (croatian): Spontaneous osteonecrosis of the knee (SONK)
• Author: Valentina Delimar
• Author: Andrija Jurina
• Author: Damjan Dimnjaković
• Author: Ivan Bojanić
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Spontaneous osteonecrosis of the knee (SONK) is the most common type of knee osteonecrosis. It
causes subchondral bone damage and in the majority of cases leads to cartilage damage and secondary osteoarthritis.
The etiology is commonly explained with two main theories, vascular and traumatic. Vascular theory is
based on disrupture of bone blood supply which causes local ischaemia and subchondral bone necrosis. Traumatic
theory suggests the development of subchondral insufficiency fractures due to mechanical overload, which
causes local oedema, ischaemia and necrosis. SONK typically appears in middle age and older women, with acute
onset of sharp pain in the medial femoral condyle without predisposing trauma. Considering that the characteristic
radiological signs are not seen on conventional radiography until advanced stage, magnetic resonance
imaging is the gold standard in diagnostics. Treatment depends on the size and stage of the osteonecrotic lesion.
Small osteonecrotic lesions are usually successfully treated non-operatively, which is based primarily on protected
weight bearing and physical therapy. Medium osteonecrotic lesions are treated either non-operatively or operatively,
while large osteonecrotic lesions are almost always treated operatively. Most commonly used joint preserving
procedures include arthroscopic bone marrow stimulation using microfracture technique, core decompression,
osteochondral autologous or homologous transplantation, artificial graft transplantation, and medial
opening-wedge high tibial osteotomy. The treatment of choice after subchondral bone collapse is knee
arthroplasty.

Abstract (croatian)

Spontana osteonekroza koljena (SONK) najčešći je tip osteonekroze koljena koji dovodi do oštećenja
suphondralne kosti i, u najvećeg broja bolesnika, do propadanja zglobne hrskavice te nastanka sekundarnog
osteoartritisa. Nastanak SONK-a objašnjava se dvjema teorijama, vaskularnom i traumatskom. Vaskularna teorija
zasniva se na postojanju poremećaja u opskrbi kosti krvlju zbog čega dolazi do lokalizirane ishemije i nekroze
suphondralne kosti. Prema traumatskoj teoriji, zbog povećanoga mehaničkog stresa nastaju frakture u insuficijentnoj
suphondralnoj kosti, stvara se lokalni edem te dolazi do ishemije i nekroze. SONK se najčešće javlja u žena
srednje i starije životne dobi, kao spontana, naglo nastala bol u području medijalnog kondila femura, i to bez
prethodne traume. S obzirom na to da se na standardnim radiološkim snimkama karakteristični znakovi javljaju
tek u uznapredovalom stadiju, zlatni standard za postavljanje dijagnoze jest magnetska rezonancija. Liječenje
ovisi o veličini i stadiju osteonekrotičnog oštećenja. Mala oštećenja nižeg stupnja uglavnom se uspješno liječe
konzervativno, i to u prvom redu rasterećenjem zahvaćenog ekstremiteta pri hodu uz provođenje fizikalne terapije.
Srednje velika oštećenja liječe se ili konzervativno ili kirurški, dok se velika oštećenja gotovo uvijek liječe kirurški.
Od tzv. poštednih kirurških metoda rabe se artroskopska stimulacija koštane srži tehnikom mikrofraktura, dekompresija
koštane srži, ugradnja koštanohrskavičnog autolognog ili homolognog presatka, ugradnja umjetnog
presatka
te korektivna osteotomija otvaranja s medijalne strane proksimalne tibije. No, nakon što dođe do kolapsa
suphondralne kosti jedini izbor liječenja jest ugradnja endoproteze koljena.

• Language: english
• Publication type: Scientific paper - Review paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 141, no. 3-4, pp. 81-90
• p-ISSN: 0024-3477
• URN:NBN: urn:nbn:hr:105:850161
• Publication: 2019
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 10:22:51