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Regeneration artikulärer Knorpeldefekte am Kniegelenk

Differenzialindikationen chirurgischer Techniken

Regeneration of articular chondral defects of the knee joint

Differential indications of surgical techniques

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Knorpelgewebe besitzt keine Fähigkeit zur Eigenregeneration, sodass die chirurgische Knorpeltherapie ein essenzielles Verfahren in der Behandlung von Knorpelschäden darstellt. Die Indikation richtet sich nicht nur nach der Größe und morphologischen Beschaffenheit des Schadens, sondern insbesondere nach der klinischen Symptomatik. Die Mikrofrakturierung stellt ein validiertes Verfahren für kleine Defekte dar, ist jedoch der autologen Chondrozytentransplantation (ACT/MACT) in der histologischen Qualität etwas unterlegen. Die ACT/MACT kann mittlerweile in offener und rein arthroskopischer Technik angewendet werden und ist der Mikrofrakturierung hinsichtlich der klinischen Behandlungsergebnisse ebenbürtig bzw. bei großen Defekten sogar überlegen. Nachteilig ist jedoch weiterhin das notwendige zweizeitige Verfahren. Zellfreie Behandlungsmethoden bieten daher als einzeitige Verfahren eine gute Alternative und zeigten in ersten Studien vielversprechende Ergebnisse. Systematische Langzeitstudien und randomisierte Studien sind jedoch notwendig, um das Potenzial dieser Behandlungsstrategien zu evaluieren und sie mit traditionellen Therapiealternativen suffizient vergleichen zu können. Begleitpathologien bzw. Risikofaktoren müssen in der chirurgischen Knorpeltherapie unbedingt beachtet und ggf. mit therapiert werden.

Abstract

Cartilage tissue does not have the ability for self-regeneration, making surgical cartilage treatment an essential procedure in the treatment of chondral damage. The indications are based not only on the size and morphological nature of the damage but also especially on the clinical symptoms. Microfracturing represents a validated procedure for small defects but is slightly inferior to autologous chondrocyte transplantation (ACT/MACT) in histological quality. The ACT/MACT can now be used in an open and purely arthroscopic technique and is equal to microfracturing in terms of clinical treatment results and even superior for large defects; however, the disadvantage is still the necessary 2‑step process. Cell-free treatment methods therefore offer a suitable alternative as a 1-step procedure and have shown promising results in initial studies. Systematic long-term studies and randomized trials are still needed to evaluate the potential of these treatment strategies and to sufficiently compare them with traditional alternative forms of treatment. Strict attention must be paid to concomitant pathologies and risk factors in surgical cartilage treatment and, if necessary, also be treated.

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Authors and Affiliations

  1. Abteilung für Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung Augsburg, Hessingstr. 17, 86199, Augsburg, Deutschland

    F. Blanke & S. Vogt

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  1. F. Blanke
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  2. S. Vogt
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Correspondence to S. Vogt.

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Interessenkonflikt

F. Blanke und S. Vogt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Blanke, F., Vogt, S. Regeneration artikulärer Knorpeldefekte am Kniegelenk. Arthroskopie 32, 182–186 (2019). https://doi.org/10.1007/s00142-019-0277-3

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  • DOI: https://doi.org/10.1007/s00142-019-0277-3

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