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MR-tomographische Degenerationsmuster bei berufsbedingter Gonarthrose
Hinweise für ein belastungskonformes Schadensbild

Aim: By means of MR we have studied the distribution of degenerative lesions in patients with knee osteoarthritis (OA) in association with work-related knee stress and overweight to search for a typical pattern of occupation-related knee OA.
Method: MR images of 114 symptomatic patients (age 21–54) without history of traumatic injury were evaluated with a modified wholeorgan magnetic resonance imaging score (WORMS). The study cohort was divided into four groups based on the presence of the risk factors overweight (cut-off BMI < 26) and work-related knee stress (measured with the Tegner score, work positions including kneeling, squatting and climbing ladders).
Results: The WORMS for the whole knee joint and the three joint compartments were increased significantly and additively in the presence of work-related knee stress and overweight (p < 0.002). The degree of degeneration was evenly distributed between the medial (MP) and lateral (LP) patellar joint surface in both overweight and normal weight patients without work-related knee stress. Occupation- related joint load was associated with a significantly increased difference MP-LP (ANOVA a priori contrast –1/1/–1/1, p = 0.001) and a higher WORMS for the medial patellofemoral joint (p = 0.002), compared with controls. Evenly distributed or more lateral patellofemoral degeneration showed a negative predictive value of 80 % for the exclusion of relevant occupation-related joint stress.
Conclusions: WORMS is a useful tool for evaluating patterns of degeneration in work-related knee OA. A higher WORMS on the medial patellofemoral joint surface is an indicator of occupational knee stress in both normal weight and overweight patients. Joint derangement in patients with occupational knee stress and excess weight affects all joint compartments.