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Möglichkeiten und Grenzen des „tissue engineering“ des vorderen Kreuzbandes

Possibilities and limits in tissue engineering of the anterior cruciate ligament

  • Leitthema
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Zusammenfassung

Aktuelle Methoden zur Kreuzbandrekonstruktion mit Sehnentransplantaten erfüllen mittelfristig ihren Zweck der Kniegelenkstabilisierung, jedoch kann der komplexe, dreidimensionale anatomische Aufbau eines vorderen Kreuzbandes mit einem singulären oder auch doppelten Sehnenstrang nur unzureichend wiederhergestellt werden. Deshalb versucht man, mit Hilfe des „tissue engineering“ Alternativen zu finden. Das Prinzip ist die Besiedelung eines resorbierbaren Trägermaterials mit geeigneten Zellen, die durch biologische und mechanische Stimulation eine bandähnliche extrazelluläre Matrix generieren sollen und die anschließende Implantation als Kreuzbandersatz. Es wurden verschiedene natürliche und synthetische Materialien und ihre generelle Eignung als Zellträger beschrieben. Allerdings weisen die meisten Materialien eine zu geringe Zug- und Verschleißfestigkeit auf, was einen zusätzlichen temporären Lastträger erfordert. Es konnte gezeigt werden, dass ein biologisch induzierter Kreuzbandersatz grundsätzlich das Potential hat, Konstrukte mit bandähnlicher Matrix zu erzeugen, der Schritt von der Grundlagenforschung zur klinischen Anwendbarkeit jedoch noch nicht vollzogen werden konnte.

Abstract

Although current concepts of cruciate ligament reconstruction using tendon transplants provide midterm knee joint stabilization, a single-bundle or double-bundle tendon cannot adequately restore the complex three-dimensional structure of the anterior cruciate ligament. Therefore, researchers are attempting to develop alternatives using tissue engineering technology. The basic principle includes seeding of suitable cells on a resorbable carrier construct, in vitro biological and mechanical stimulation to generate a ligament-like extracellular matrix, and subsequent implantation as a cruciate ligament bioprosthesis. Several natural and synthetic materials have proven to be suitable as cell carriers; however, most of these exhibit inadequate tensile strength as well as minor fatigue properties, making an additional load carrier necessary. In principle, research has shown that tissue engineering technology is capable of generating a construct with a ligament-like extracellular matrix. However, the step from basic research to clinical application has not yet been taken.

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  1. Zentrum für Muskuloskelettale Forschung, Institut für Unfallchirurgische Forschung und Biomechanik, Universitätsklinikum, Helmholtzstraße 14, 89081, Ulm, Deutschland

    A. Ignatius & L. Dürselen

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  1. A. Ignatius
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  2. L. Dürselen
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Correspondence to A. Ignatius.

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Ignatius, A., Dürselen, L. Möglichkeiten und Grenzen des „tissue engineering“ des vorderen Kreuzbandes. Orthopäde 38, 1080–1086 (2009). https://doi.org/10.1007/s00132-009-1492-9

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