Department of Orthopaedic Surgery, Sinai Hospital, Baltimore, MD, USA.
J Am Acad Orthop Surg. 2011 Aug;19(8):482-94. doi: 10.5435/00124635-201108000-00004.
Osteonecrosis (ON) of the knee is a progressive disease that often leads to subchondral collapse and disabling arthritis. Recent studies have identified three distinct pathologic entities, all of which were previously described as knee ON: secondary ON, spontaneous ON of the knee, and postarthroscopic ON. Radiographic and clinical assessment is useful for differentiating these conditions, predicting disease progression, and distinguishing these conditions from other knee pathologies. The etiology, pathology, and pathogenesis of secondary ON of the knee are similar to those found at other sites (eg, hip, shoulder). Spontaneous ON is a disorder of unknown etiology. Postarthroscopic ON has been described as an infrequent but potentially destructive complication. Various treatment modalities (eg, core decompression, bone grafting, high tibial osteotomy, arthroplasty), have been used with varying degrees of success for each type of ON. Secondary ON frequently progresses to end-stage disease, and early surgical intervention is recommended. Initial management of spontaneous ON of the knee and postarthroscopic ON is typically nonsurgical, with observation for clinical or radiographic progression.
膝关节骨坏死（ON）是一种进行性疾病，常导致软骨下塌陷和致残性关节炎。最近的研究确定了三种不同的病理实体，它们以前都被描述为膝关节 ON：继发性 ON、膝关节自发性 ON 和关节镜检查后 ON。影像学和临床评估有助于区分这些情况，预测疾病进展，并将这些情况与其他膝关节病变区分开来。膝关节继发性 ON 的病因、病理学和发病机制与其他部位（如髋部、肩部）相似。自发性 ON 是一种病因不明的疾病。关节镜检查后 ON 被描述为一种罕见但具有潜在破坏性的并发症。各种治疗方法（如核心减压、植骨、胫骨高位截骨、关节置换）已用于每种类型的 ON，取得了不同程度的成功。继发性 ON 常进展为终末期疾病，建议早期手术干预。膝关节自发性 ON 和关节镜检查后 ON 的初始治疗通常是非手术的，观察临床或影像学进展。
