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Möglichkeiten zur chirurgischen Therapie von Knorpeldefekten — Teil 2: Chirurgische Behandlungsoptionen zur biologischen Knorpelreparatur

Current concepts in surgical treatment of articular cartilage defects — Part 2: Surgical treatment options for biologic cartilage repair

  • Übersicht
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Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: Für die normale Gelenkfunktion ist der hyaline Knorpel zur Lastverteilung der mechanischen Kräfte und als Gleitfläche für reibungsarme Bewegungen unerläßlich. Das artikuläre Knorpelgewebe besteht aus einer einzigen Zellpopulation, integriert in ein dreidimensionales Netzwerk hochorganisierter Matrixstrukturen. Dieser feingewebliche Aufbau bestimmt die einzigartigen mechanischen Eigenschaften, limitiert aber auch die physiologischen Reparationsmöglichkeiten von Knorpeldefekten.

Methodik: Diese Übersicht beschreibt die Grundlagen der Knorpelbiologie und die Mechanismen der Knorpelreparatur, und behandelt die experimentellen und klinischen Ergebnisse chirurgischer Techniken zur biologischen Therapie umschriebener Knorpeldefekte.

Ergebnisse: Der Gelenkknorpel besitzt nur eine begrenzte Fähigkeit zur Regeneration. Die chirurgischen Techniken zur Therapie von lokalisierten Defekten der Gelenkoberfläche versuchen durch die Integration biologischer Mechanismen die mangelnde Regenerationsfähigkeit artikulären Knorpels zu überwinden. Die Techniken der Transplantation von chondrogenen Geweben wurden in jüngster Zeit durch die Defektauffüllung mit autologen Chondrozyten erweitert. Wie bei allen neuen Entwicklungen besteht sowohl Skepsis, wie auch Begeisterung und faszinierende Spannung. Zur objektiven Beurteilung ist aber auch ein gesundes Maß an kritischer Zurückhaltung erforderlich.

Schlußfolgerungen: Alle bislang zur Verfügung stehenden Methoden zur Regeneration und Reparatur von Knorpeldefekten sollten als vorläufige Ergebnisse betrachtet werden, solange sie nicht in größeren kontrollierten klinischen Studien bestätigt werden.

Summary

Background: Articular cartilage can tolerate a tremendous amount of intensive and repetitive physical stress. Cartilage is composed of chondrocytes embedded within an extracellular matrix of collagens, proteoglycans, and noncollagenous proteins. Together, these structures maintain the unique mechanical properties and manifest its striking inability to heal even the most minor injury. Both the remarkable functional characteristics and the healing limitations reflect the uniqueness of its structure and biology.

Methods: This review presents the principles of cartilage structure and the biological background of cartilage repair and gives information about the experimental and clinical experience with many of the surgical techniques for treating cartilage defects.

Results: The response of cartilage to injuries differs from that of other tissues because of its avascularity, the immobility of chondrocytes and the limited ability of mature chondrocytes to proliferate and alter their synthetic patterns. Surgical therapeutic efforts in treating cartilage defects have focused on bringing new cells and tissues capable of chondrogenesis into the lesions and facilitating the access to the vascular system.

Conclusions: Although there are many exciting new concepts that warrant enthusiasm, many questions remain. These issues need to be addressed by careful basic science investigations and both short- and long-term clinical trials using controlled, prospective, randomized study design.

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  1. Aus der Universitätsklinik für Unfallchirurgie und dem Ludwig-Boltzmann-Institut für Biomechanik und Zellbiologie, Wien

    S. Marlovits & V. Vécsei

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Teil 1: Grundlagen der Korpelbiologie und der Heilung von Knorpeldefekten in Acta Chir Austriaca 2000; 32: 124–129.

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Marlovits, S., Vécsei, V. Möglichkeiten zur chirurgischen Therapie von Knorpeldefekten — Teil 2: Chirurgische Behandlungsoptionen zur biologischen Knorpelreparatur. Acta Chir. Austriaca 32, 185–194 (2000). https://doi.org/10.1007/BF02949262

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