Zusammenfassung
Gelenkknorpelschäden des Erwachsenen haben praktisch keine Selbstheilungstendenz. Dies macht bei symptomatischen Grad-III/IV-Schäden eine operative Therapie erforderlich. Eine besondere Herausforderung sind dabei Knorpelschäden im patellofemoralen Gelenk, da hier eine komplexe Biomechanik des Gelenks häufig mit Fehlanlagen kombiniert ist. Alle Maßnahmen der Geweberegeneration basieren auf der Rekrutierung von Zellen. Die im Gelenk vorhandenen Synovialzellen lassen sich unter bestimmten mechanischen Bedingungen zu Faserknorpel differenzieren, können aber Defekte nicht suffizient auffüllen. Auch die Verwendung von Knochenmarkzellen zur Knorpelrekonstruktion lässt bisher nur einen mechanisch minderwertigen Faserknorpel (Pridie-Bohrungen, Microfracture, AMIC®) entstehen.
Für eine biomechanisch hochwertige Rekonstruktion der Knorpelschicht stehen gegenwärtig nur vermehrte autologe Chondrozyten aus dem Labor zur Verfügung. Der Einsatz von mesenchymalen Stammzellen ist Gegenstand großer internationaler Forschungsanstrengungen. Erste experimentelle Studien zeigen aber nach einer initialen Knorpelbildung eine signifikante Verknöcherung des Knorpels und damit bisher ein enttäuschendes Resultat. Wesentliche Voraussetzungen für eine erfolgreiche Behandlung von patellofemoralen Knorpelschäden sind die Diagnose von Begleitpathologien, die Auswahl des richtigen knorpelregenerativen Verfahrens, die suffiziente Beseitigung der Grundpathologie und die Anwendung einer standardisierten Rehabilitation.
Abstract
Joint cartilage damage in adults has practically no tendency to self healing. Symptomatic grade III/IV damage requires surgical treatment. There are special challenges involved in cartilage damage in the patellofemoral joint as the complicated biomechanics of the joint is often combined with dysplasia. All tissue regeneration measures are based on the recruitment of cells. The synovial cells available in the joint can be differentiated to fibrous cartilage under certain mechanical conditions; however, they cannot sufficiently fill in defects. Also the use of bone marrow cells for cartilage reconstruction only creates mechanically inferior fibrous cartilage (Pridie drillings, microfracture, AMIC®). Presently only cultivated, autologous chondrocytes from the lab are available for a biomechanically high-quality reconstruction of the cartilage layer.
The application of mesenchymal stem cells is a subject of extensive international research. However, the first experimental studies, after initial formation of cartilage, disappointingly show significant ossification. Essential conditions for a successful treatment of patellofemoral cartilage damage are the diagnosis of accompanying pathological conditions, selection of the right cartilage-regenerating procedure, sufficient removal of the basic pathological defect, and implementation of standardized rehabilitation.
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Steinwachs, M., Kreuz, P., Guhlke-Steinwachs, U. et al. Aktuelle Behandlung des Knorpelschadens im Patellofemoralgelenk. Orthopäde 37, 841–847 (2008). https://doi.org/10.1007/s00132-008-1290-9
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DOI: https://doi.org/10.1007/s00132-008-1290-9