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Intraoperative biologische Augmentation am Meniskus

Intraoperative biological augmentation techniques for meniscus surgery

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Hintergrund

Die operative Therapie von Meniskusläsionen muss nicht nur die biomechanischen, sondern auch die spezifischen biologischen Gesetzmäßigkeiten der Meniskusheilung berücksichtigen. Trotz wesentlicher Fortschritte bei den Refixations- und Nahttechniken von Meniskusläsionen mit entsprechend biomechanisch ausgereiften, minimal-invasiven Systemen ist die Versagensrate bei meniskuserhaltenden Eingriffen relevant, was auf die limitierte Vaskularisierung der zentralen Meniskuszonen zurückzuführen ist.

Methoden

Verschiedene biologische Augmentationstechniken sind beschrieben, um das Heilungspotenzial bei operativ versorgten Meniskusläsionen zu verbessern. Ungerichtete intraoperative biologische Augmentationstechniken werden bereits seit Jahren im klinischen Alltag eingesetzt, allerdings mit bisher geringem Evidenzlevel. Diese umfassen das intraläsionale bzw. parasynoviale Raspeln, die Trepanation bzw. das Needling, die Mikrofrakturierung, die Verwendung von Fibrinclots und in den letzten Jahren auch die Anwendung von thrombozytenreichen Konzentraten. Diese Maßnahmen sollen biologische, den Heilungsprozess aktivierende Substanzen liefern.

Schlussfolgerung

Neuere biologische Augmentationsverfahren, wie der gezielte intraoperative Einsatz von Wachstumsfaktoren und/oder zellbasierter Therapien von mesenchymalen Stammzellen, rücken zunehmend in den wissenschaftlichen Fokus. Die Komplexität der Heilungsvorgänge an den Menisken müssen jedoch erst im Detail erforscht und verstanden werden, bevor ein erfolgreicher Transfer in das klinische Setting gelingt.

Abstract

Background

The surgical treatment of meniscal lesions has to consider not only the biomechanical but also the specific biological principles of meniscus healing. Despite essential progress with respect to refixation and suture techniques for meniscal lesions, including biomechanically sophisticated minimally invasive systems, the failure rate of meniscus-preserving surgery is still clinically relevant. A limited vascularization of the central meniscal zones seems to be the most important factor.

Methods

Various biological augmentation techniques have been developed for enhancement of the healing ability following surgically treated meniscal lesions. Non-directive intraoperative biological augmentation techniques have already been established in the clinical setting for many years; however, the evidence level of these procedures is still low. Intralesional and parasynovial rasping, trephination, needling, microfracturing, use of fibrin clots and recently the application of platelet-rich concentrates are all included under these intraoperative biological augmentation techniques.

Conclusion

Overall, these interventions can provide biologically active substrates for improved healing. Novel biological augmentation procedures, e.g. specific intraoperative use of growth factors and/or cell-based therapies of mesenchymal stem cells, are under scientific investigation. However, the complexity of the healing processes in the menisci must be studied and understood in detail before a successful transfer into the clinical setting can be realized.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Peter U. Brucker, Matthias J. Feucht und Roland Becker: kein Interessenkonflikt. Stefan Hinterwimmer und Andreas B. Imhoff haben eine beratende Funktion bei der Firma Arthrex (Karlsfeld, Deutschland). Dirk Holsten hat eine beratende Funktion bei der Firma Ivy Sports Medicine (Gräfelfing, Deutschland).

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Authors and Affiliations

  1. Abteilung für Sportorthopädie am Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    P.U. Brucker Dipl.-Sportl., M.J. Feucht, S. Hinterwimmer & A.B. Imhoff

  2. Zentrum für Orthopädie und Unfallchirurgie, Städtisches Klinikum Brandenburg, Brandenburg, Deutschland

    R. Becker

  3. Sportsclinic Germany, München, Deutschland

    S. Hinterwimmer

  4. Klinik für Orthopädie und Unfallchirurgie, Katholisches Klinikum Koblenz - Montabaur, Koblenz - Montabaur, Deutschland

    D. Holsten

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  1. P.U. Brucker Dipl.-Sportl.
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  3. R. Becker
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  4. S. Hinterwimmer
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Correspondence to P.U. Brucker Dipl.-Sportl..

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Brucker, P., Feucht, M., Becker, R. et al. Intraoperative biologische Augmentation am Meniskus. Arthroskopie 26, 105–113 (2013). https://doi.org/10.1007/s00142-012-0736-6

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