Zusammenfassung
Das Thema „Meniskusersatz“ nahm in der letzten Dekade deutlich an Priorität zu. Vorläufer aus nichtresorbierbaren Kunststoffen wie Dacron oder Teflon wurden wegen des Materialabriebs und der daraus resultierenden Synovitiden verlassen. Auch der Einsatz von eigenem Gewebe wie Fett, Periost oder Sehne hat sich als Meniskusersatz nicht bewährt. Die experimentelle Forschung richtete sich in den letzten 15 Jahren auf die Entwicklung resorbierbarer poröser Meniskus-Scaffolds. Verschiedene Materialien und Polymere aus Kollagenen, Polyurethanen, Polylactaten, Polyglykolen, Gelatine, Hyaluronsäure, Capronolactonen oder Alkohol-Hydrogelen wurden in zahlreichen Experimenten untersucht. Bei den meisten dieser Konstrukte wurden eine gute Biokompatibilität, Integration, Resorption und Regeneration festgestellt. Zwei der Implantate werden inzwischen klinisch eingesetzt. Das Kollagen Meniscus Implant (CMI®), erstmals vor 13 Jahren bei Patienten implantiert, wurde in den USA im Rahmen einer Multicenterstudie und ungeachtet der fehlenden Datenlage gleichzeitig in Europa zum Einsatz an Patienten zugelassen. Trotz der subjektiven Verbesserung der Symptome in den wenigen vorhandenen Studien ist ein Nachweis zur Verbesserung der Meniskusfunktion bisher ausgeblieben. Neuerdings wird im Rahmen einer klinischen Studie ein Meniskusimplantat aus Polyurethanen (Actifit®) getestet.
Abstract
Meniscus replacement attained an increased priority in the last decade. Precursors made from non-absorbable synthetics, such as dacron or teflon, were abandoned due to abrasive wear and the resulting synovitis. Also the application of autologous tissue in the form of fat, periosteum or tendons did not prove to be suitable for meniscus replacement. The experiments in the last 15 years pointed to the development of absorbable porous meniscus scaffolds. Various materials and polymers made from collagens, polyurethanes, polylactates, polyglycols, gelatines, hyaluronic acid, capronolactones or alcohol hydrogels were investigated in numerous experiments. Most of these constructs showed good biocompatibility, integration, absorption and regeneration. In the meantime, two implants have been clinically introduced. The collagen meniscus implant (CMI®), first implanted in patients 13 years ago, was approved in the USA for inclusion in a multicenter study and, regardless lacking clinical data simultaneously in Europe for application in patients. Despite subjective improvements of symptoms in the few available clinical studies, a proof of improvements in meniscus function is still lacking. A porous polyurethane meniscus scaffold (Actifit®) is currently being tested in a clinical study.
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Martinek, V., Imhoff, A. Das künstliche Meniskusimplantat. Arthroskopie 21, 266–270 (2008). https://doi.org/10.1007/s00142-008-0472-0
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DOI: https://doi.org/10.1007/s00142-008-0472-0