Zusammenfassung
Die Tatsache, dass Gelenkknorpel nicht oder nur insuffizient heilt, ist altbekannt (Hunter 1747). Der umschriebene Knorpelschaden steht oft am Beginn der Gelenksdegeneration, die zur Entwicklung einer schmerzhaften und mobilitätseinschränkenden Arthrose führt. Das Zusammenspiel von Alterung, Degeneration und Inflammation führt zu einem komplexen Abbau der Gelenkfunktion und betrifft bis zu 20 % der Gesamtbevölkerung. Daher werden seit Jahrzehnten sehr aufwendige Versuche unternommen, die ungenügende Regenerationsfähigkeit von Knorpel zu verbessern. Operationsmethoden wie Bohrung und Mikrofrakturierung stimulieren durch Blutungsinduktion eine Vernarbung des Defektes, was zu ungenügendem Heilungsgewebe führt. Die osteochondrale Transplantation von Knochen-Knorpelzylindern zur Behandlung von Knorpeldefekten ist limitiert verfügbar und kann nur für kleinere Defekte eingesetzt werden. Die Implantation von kultivierten, autologen Chondrozyten bei akuten und chronischen Knorpeldefekten erzielte sowohl experimentell als auch in ersten klinischen Anwendungen eine verbesserte Regeneration von hyalinem Gelenkknorpel. Die Einführung von Biomaterialien in der Knorpelzelltransplantation hat zur Entwicklung der Methoden des Tissue Engineering geführt, die sicher dazu beitragen, die Prognose bei der Behandlung von Knorpeldefekten noch weiter zu verbessern, und die Entstehung einer Arthrose zu verhindern. Kommt es dennoch zur Entwicklung einer Osteoarthrose – als komplexer Degenerations- und Inflammationsprozess können einerseits Nahrungsergänzungsmittel oder/und anti-inflammatorische Medikamente eingesetzt werden, um die Progression der Degeneration zu verlangsamen oder zu verhindern. Neue Therapiekonzepte mit Blutderivaten, wie plättchenreiches-Plasma (PRP) helfen, die Homöostase des Gelenkes wieder herzustellen, sind aber in ihrem Wirkmechanismus bzw. der Evidenz noch ungenügend erforscht. Hyaluronsäure und Cortison gehören zu den am häufigsten angewendeten Injektionstherapien, wobei Cortison aufgrund der katabolen Effekte nur eingeschränkt – bei sehr akuten Entzündungszuständen empfohlen werden kann. Die Zukunft liegt hier sicher in der regulatorischen Beeinflussung der Inflammation und Immunmodulation, sowie Unterstützung des regenerativen Potenzials.
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Nehrer, S., Neubauer, M. (2023). Knorpelschaden und Arthrose des Kniegelenkes. In: Engelhardt, M., Raschke, M. (eds) Orthopädie und Unfallchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54673-0_311-1
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