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Aktuelle Übersicht knorpelregenerativer Verfahren

Current overview of cartilage regeneration procedures

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Zusammenfassung

Hintergrund

Bei Knorpelgewebe handelt es sich um ein avaskuläres, alymphatisches und nicht innerviertes Gewebe mit einem geringen intrinsischen Reparationspotenzial. Aufgrund der hohen Prävalenz und der klinischen Bedeutung von Knorpelschäden stellen diese bis heute eine Herausforderung für die behandelnden Ärzte dar.

Ziel

Der vorliegende Artikel soll den Lesern einen Überblick über die aktuell verfügbaren Knorpeldefekttherapien geben und über ihre Ergebnisse informieren.

Methoden

Die Mikrofrakturierung stellt bis heute den Goldstandard in der Behandlung von kleinen Knorpeldefekten dar. Zur Therapie von umschriebenen, kleinen osteochondralen Defekten kann das osteochondrale autologe Transplantationssystem (OATS) eingesetzt werden. Größere Defekte lassen sich erfolgreich mit der autologen matrixinduzierten Chondrogenese (AMIC) behandeln oder mit der matrixassoziierten autologen Chondrozytentransplantation (MACT).

Zusammenfassung

Trotz bestehender Limitationen der aktuellen Knorpeldefekttherapien kann durch diese eine kurz- bis mittelfristige Verbesserung des Beschwerdebildes bei Patienten mit lokalen Knorpelschäden erreicht werden. Weitere Entwicklungen und Studien sind notwendig, um langfristig gute Ergebnisse nach einer Knorpeltherapie zu erreichen.

Abstract

Background

Cartilage is an avascular, alymphatic and non-innervated tissue with limited intrinsic repair potential. The high prevalence of cartilage defects and their tremendous clinical importance are a challenge for all treating physicians.

Aim

This article provides the reader with an overview about current cartilage treatment options and their clinical outcome.

Methods

Microfracture is still considered the gold standard in the treatment of small cartilage lesions. Small osteochondral defects can be effectively treated with the autologous osteochondral transplantation system. Larger cartilage defects are successfully treated by autologous membrane-induced chondrogenesis (AMIC) or by membrane-assisted autologous chondrocyte implantation (MACI).

Conclusion

Despite limitations of current cartilage repair strategies, such procedures can result in short- and mid-term clinical improvement of the patients. Further developments and clinical studies are necessary to improve the long-term outcome following cartilage repair.

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Abbreviations

ACT:

Autologe Chondrozytentransplantation

AMIC:

Autologe matrixinduzierte Chondrogenese

ICRS:

International Cartilage Repair Society

IKDC:

International Knee Documentation Committee Score

KOOS:

Knee Injury and Osteoarthritis Outcome Score

MACT:

Matrixassoziierte autologe Chondrozytentransplantation

MOCART:

Magnetic Resonance Observation of Cartilage Repair Tissue Score

MSC:

Mesenchymale Stammzellen

OATS:

Osteochondrales autologes Transplantationssystem

PRP:

Plättchenreiches Thrombozytenkonzentrat

SF-36:

36-item Short Form Survey

VAS:

Visuelle Analoge Schmerzskala

Literatur

  1. Aigner J, Tegeler J, Hutzler P et al (1998) Cartilage tissue engineering with novel nonwoven structured biomaterial based on hyaluronic acid benzyl ester. J Biomed Mater Res 42:172–181

    Article  CAS  PubMed  Google Scholar 

  2. Angele P, Niemeyer P, Steinwachs M et al (2016) Chondral and osteochondral operative treatment in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24(6):1743–1752

    Article  PubMed  Google Scholar 

  3. Barlic A, Drobnic M, Malicev E et al (2008) Quantitative analysis of gene expression in human articular chondrocytes assigned for autologous implantation. J Orthop Res 26:847–853

    Article  CAS  PubMed  Google Scholar 

  4. Basad E, Ishaque B, Bachmann G et al (2010) Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 18:519–527

    Article  PubMed  Google Scholar 

  5. Behrens P (2005) Matrixgekoppelte Mikrofrakturierung. Arthroskopie 18:193–197

    Article  Google Scholar 

  6. Bekkers JE, Inklaar M, Saris DB (2009) Treatment selection in articular cartilage lesions of the knee: a systematic review. Am J Sports Med 37(Suppl 1):148S–155S

    Article  PubMed  Google Scholar 

  7. Benthien JP, Behrens P (2010) Autologous matrix-induced chondrogenesis (AMIC). A one-step procedure for retropatellar articular resurfacing. Acta Orthop Belg 76:260–263

    PubMed  Google Scholar 

  8. Benthien JP, Behrens P (2011) The treatment of chondral and osteochondral defects of the knee with autologous matrix-induced chondrogenesis (AMIC): method description and recent developments. Knee Surg Sports Traumatol Arthrosc 19:1316–1319

    Article  PubMed  Google Scholar 

  9. Bentley G, Biant LC, Carrington RW et al (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85:223–230

    Article  CAS  PubMed  Google Scholar 

  10. Bhosale AM, Richardson JB (2008) Articular cartilage: structure, injuries and review of management. Br Med Bull 87:77–95

    Article  PubMed  Google Scholar 

  11. Braun S, Minzlaff P, Hollweck R et al (2008) The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study. Arthritis Res Ther 10:R68

    Article  PubMed  PubMed Central  Google Scholar 

  12. Brittberg M (2010) Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure. Am J Sports Med 38:1259–1271

    Article  PubMed  Google Scholar 

  13. Brittberg M, Peterson L, Sjogren-Jansson E et al (2003) Articular cartilage engineering with autologous chondrocyte transplantation. A review of recent developments. J Bone Joint Surg Am 85-A(Suppl 3):109–115

    Article  Google Scholar 

  14. Brown WE, Potter HG, Marx RG et al (2004) Magnetic resonance imaging appearance of cartilage repair in the knee. Clin Orthop Relat Res 2004(422):214–223

    Article  Google Scholar 

  15. Brucker PU, Braun S, Imhoff AB (2008) Mega-OATS technique – autologous osteochondral transplantation as a salvage procedure for large osteochondral defects of the femoral condyle. Oper Orthop Traumatol 20:188–198

    Article  PubMed  Google Scholar 

  16. Buckwalter JA (2002) Articular cartilage injuries. Clin Orthop Relat Res 2002(402):21–37

    Article  Google Scholar 

  17. Crawford DC, Deberardino TM, Williams RJ 3rd (2012) NeoCart, an autologous cartilage tissue implant, compared with microfracture for treatment of distal femoral cartilage lesions: an FDA phase-II prospective, randomized clinical trial after two years. J Bone Joint Surg Am 94:979–989

    Article  PubMed  Google Scholar 

  18. Crawford DC, Heveran CM, Cannon WD Jr. et al (2009) An autologous cartilage tissue implant NeoCart for treatment of grade III chondral injury to the distal femur: prospective clinical safety trial at 2 years. Am J Sports Med 37:1334–1343

    Article  PubMed  Google Scholar 

  19. Devitt BM, Bell SW, Webster KE et al (2017) Surgical treatments of cartilage defects of the knee: Systematic review of randomised controlled trials. Knee 24(3):508. https://doi.org/10.1016/j.knee.2016.12.002

    Article  PubMed  Google Scholar 

  20. Ebert JR, Robertson WB, Woodhouse J et al (2011) Clinical and magnetic resonance imaging-based outcomes to 5 years after matrix-induced autologous chondrocyte implantation to address articular cartilage defects in the knee. Am J Sports Med 39:753–763

    Article  PubMed  Google Scholar 

  21. Erggelet C, Vavken P (2016) Microfracture for the treatment of cartilage defects in the knee joint – A golden standard? J Clin Orthop Trauma 7:145–152

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gaissmaier C, Koh JL, Weise K et al (2008) Future perspectives of articular cartilage repair. Injury 39(Suppl 1):S114–S120

    Article  PubMed  Google Scholar 

  23. Gigante A, Calcagno S, Cecconi S et al (2011) Use of collagen scaffold and autologous bone marrow concentrate as a one-step cartilage repair in the knee: histological results of second-look biopsies at 1 year follow-up. Int J Immunopathol Pharmacol 24:69–72

    Article  CAS  PubMed  Google Scholar 

  24. Gille J, Behrens P, Volpi P et al (2013) Outcome of Autologous Matrix Induced Chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC Registry. Arch Orthop Trauma Surg 133:87–93

    Article  CAS  PubMed  Google Scholar 

  25. Gille J, Meisner U, Ehlers EM et al (2005) Migration pattern, morphology and viability of cells suspended in or sealed with fibrin glue: a histomorphologic study. Tissue Cell 37:339–348

    Article  CAS  PubMed  Google Scholar 

  26. Gille J, Schuseil E, Wimmer J et al (2010) Mid-term results of Autologous Matrix-Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 18:1456–1464

    Article  CAS  PubMed  Google Scholar 

  27. Gomoll AH, Farr J, Gillogly SD et al (2010) Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am 92:2470–2490

    CAS  PubMed  Google Scholar 

  28. Gudas R, Kalesinskas RJ, Kimtys V et al (2005) A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 21:1066–1075

    Article  PubMed  Google Scholar 

  29. Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 85-A(Suppl 2):25–32

    Article  Google Scholar 

  30. Harris JD, Siston RA, Brophy RH et al (2011) Failures, re-operations, and complications after autologous chondrocyte implantation – a systematic review. Osteoarthr Cartil 19:779–791

    Article  CAS  PubMed  Google Scholar 

  31. Horas U, Pelinkovic D, Herr G et al (2003) Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am 85-A:185–192

    Article  CAS  PubMed  Google Scholar 

  32. Jackson DW, Lalor PA, Aberman HM et al (2001) Spontaneous repair of full-thickness defects of articular cartilage in a goat model. A preliminary study. J Bone Joint Surg Am 83-A:53–64

    Article  CAS  PubMed  Google Scholar 

  33. Koh YG, Kwon OR, Kim YS et al (2016) Adipose-derived mesenchymal stem cells with microfracture versus microfracture alone: 2‑year follow-up of a prospective randomized trial. Arthroscopy 32:97–109

    Article  PubMed  Google Scholar 

  34. Kramer J, Bohrnsen F, Lindner U et al (2006) In vivo matrix-guided human mesenchymal stem cells. Cell Mol Life Sci 63:616–626

    Article  CAS  PubMed  Google Scholar 

  35. Kreuz PC, Erggelet C, Steinwachs MR et al (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186

    Article  PubMed  Google Scholar 

  36. Krych AJ, Harnly HW, Rodeo SA et al (2012) Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: a retrospective comparative study. J Bone Joint Surg Am 94:971–978

    Article  PubMed  Google Scholar 

  37. Kusano T, Jakob RP, Gautier E et al (2012) Treatment of isolated chondral and osteochondral defects in the knee by autologous matrix-induced chondrogenesis (AMIC). Knee Surg Sports Traumatol Arthrosc 20:2109–2115

    Article  PubMed  Google Scholar 

  38. Manco A, Goderecci R, Rughetti A et al (2016) Microfracture versus microfracture and platelet-rich plasma: arthroscopic treatment of knee chondral lesions. A two-year follow-up study. Joints 4:142–147

    Article  PubMed  PubMed Central  Google Scholar 

  39. Marlovits S, Striessnig G, Resinger CT et al (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52:310–319

    Article  PubMed  Google Scholar 

  40. Masri M, Lombardero G, Velasquillo C et al (2007) Matrix-encapsulation cell-seeding technique to prevent cell detachment during arthroscopic implantation of matrix-induced autologous chondrocytes. Arthroscopy 23:877–883

    Article  PubMed  Google Scholar 

  41. Matsusue Y, Yamamuro T, Hama H (1993) Arthroscopic multiple osteochondral transplantation to the chondral defect in the knee associated with anterior cruciate ligament disruption. Arthroscopy 9:318–321

    Article  CAS  PubMed  Google Scholar 

  42. Miller BS, Steadman JR, Briggs KK et al (2004) Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 17:13–17

    Article  PubMed  Google Scholar 

  43. Minzlaff P, Braun S, Haller B et al (2010) Autologous transfer of the posterior femoral condyle for large osteochondral lesions of the knee: 5‑year results of the Mega-OATS technique. Orthopäde 39:631–636

    Article  CAS  PubMed  Google Scholar 

  44. Mithoefer K, Williams RJ 3rd, Warren RF et al (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87:1911–1920

    Article  PubMed  Google Scholar 

  45. Muller S, Breederveld RS, Tuinebreijer WE (2010) Results of osteochondral autologous transplantation in the knee. Open Orthop J 4:111–114

    PubMed  PubMed Central  Google Scholar 

  46. Mundi R, Bedi A, Chow L et al (2016) Cartilage restoration of the knee: a systematic review and meta-analysis of level 1 studies. Am J Sports Med 44:1888–1895

    Article  PubMed  Google Scholar 

  47. Nehrer S, Dorotka R, Domayer S et al (2009) Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years’ follow-up. Am J Sports Med 37(Suppl 1):81S–87S

    Article  PubMed  Google Scholar 

  48. Niemeyer P, Lenz P, Kreuz PC et al (2010) Chondrocyte-seeded type I/III collagen membrane for autologous chondrocyte transplantation: prospective 2‑year results in patients with cartilage defects of the knee joint. Arthroscopy 26:1074–1082

    Article  PubMed  Google Scholar 

  49. Pareek A, Reardon PJ, Macalena JA et al (2016) Osteochondral autograft transfer versus microfracture in the knee: a meta-analysis of prospective comparative studies at midterm. Arthroscopy 32:2118–2130

    Article  PubMed  Google Scholar 

  50. Pascarella A, Ciatti R, Pascarella F et al (2010) Treatment of articular cartilage lesions of the knee joint using a modified AMIC technique. Knee Surg Sports Traumatol Arthrosc 18:509–513

    Article  PubMed  Google Scholar 

  51. Piontek T, Ciemniewska-Gorzela K, Szulc A et al (2012) All-arthroscopic AMIC procedure for repair of cartilage defects of the knee. Knee Surg Sports Traumatol Arthrosc 20:922–925

    Article  PubMed  Google Scholar 

  52. Pridie K (1959) A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg 31:618

    Google Scholar 

  53. Richter DL, Schenck RC Jr., Wascher DC et al (2016) Knee articular cartilage repair and restoration techniques: a review of the literature. Sports Health 8:153–160

    Article  PubMed  Google Scholar 

  54. Richter W (2009) Mesenchymal stem cells and cartilage in situ regeneration. J Intern Med 266:390–405

    Article  CAS  PubMed  Google Scholar 

  55. Rodrigo JJ et al (1994) Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg 7:109–116

    Google Scholar 

  56. Saris D, Price A, Widuchowski W et al (2014) Matrix-applied characterized autologous cultured chondrocytes versus microfracture: two-year follow-up of a prospective randomized trial. Am J Sports Med 42:1384–1394

    Article  PubMed  Google Scholar 

  57. Schiavone Panni A, Cerciello S, Vasso M (2011) The manangement of knee cartilage defects with modified amic technique: preliminary results. Int J Immunopathol Pharmacol 24:149–152

    Article  CAS  PubMed  Google Scholar 

  58. Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553

    Article  CAS  PubMed  Google Scholar 

  59. Smith GD, Knutsen G, Richardson JB (2005) A clinical review of cartilage repair techniques. J Bone Joint Surg Br 87:445–449

    Article  CAS  PubMed  Google Scholar 

  60. Solheim E, Oyen J, Hegna J et al (2010) Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc 18:504–508

    Article  PubMed  Google Scholar 

  61. Steadman JR, Briggs KK, Rodrigo JJ et al (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484

    Article  PubMed  Google Scholar 

  62. Steadman JR, Rodkey WG, Briggs KK (2002) Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes. J Knee Surg 15:170–176

    PubMed  Google Scholar 

  63. Tallheden T, Dennis JE, Lennon DP et al (2003) Phenotypic plasticity of human articular chondrocytes. J Bone Joint Surg Am 85-A(Suppl 2):93–100

    Article  Google Scholar 

  64. Vannini F, Battaglia M, Buda R et al (2012) „One step“ treatment of juvenile osteochondritis dissecans in the knee: clinical results and T2 mapping characterization. Orthop Clin North Am 43:237–244

    Article  PubMed  Google Scholar 

  65. Vasiliadis HS, Danielson B, Ljungberg M et al (2010) Autologous chondrocyte implantation in cartilage lesions of the knee: long-term evaluation with magnetic resonance imaging and delayed gadolinium-enhanced magnetic resonance imaging technique. Am J Sports Med 38:943–949

    Article  PubMed  Google Scholar 

  66. Volz M, Schaumburger J, Frick H et al (2017) A randomized controlled trial demonstrating sustained benefit of Autologous Matrix-Induced Chondrogenesis over microfracture at five years. Int Orthop 41:797–804

    Article  PubMed  Google Scholar 

  67. Vrahas MS, Mithoefer K, Joseph D (2004) The long-term effects of articular impaction. Clin Orthop Relat Res 2004(423):40–43

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    H. Schenker, B. Rath, M. Tingart, A. Driessen, V. Quack &  M. Betsch

  2. Klinik für Orthopädie, Unfall- und Handchirurgie, Klinikum Darmstadt, Grafenstraße 9, 64283, Darmstadt, Deutschland

    M. Wild

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  1. H. Schenker
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H. Schenker, M. Wild, B. Rath, M. Tingart, A. Driessen, V. Quack und M. Betsch geben an, dass kein Interessenkonflikt besteht.

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Schenker, H., Wild, M., Rath, B. et al. Aktuelle Übersicht knorpelregenerativer Verfahren. Orthopäde 46, 907–913 (2017). https://doi.org/10.1007/s00132-017-3474-7

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