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Zellfreie Biomaterialien zur Knorpelregeneration

Unterschiede und Vorteile diverser Materialien

Cell-free biomaterials for cartilage regeneration

Differences and advantages of various materials

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Biomaterialien gewinnen in der knorpelrekonstruktiven Chirurgie zunehmend an Bedeutung. Dabei sollen sie die Bildung einer funktionsfähigen Knorpelmatrix unterstützen, die in der Lage ist, mit den gesunden Umgebungsstrukturen im Defekt zu fusionieren und vergleichbare biomechanische Eigenschaften zum hyalinen Gelenkknorpel abzurufen. Derzeit werden verschiedene Trägermaterialien angeboten, die als mono-, bi- oder sogar triphasische Gerüststrukturen zur Behandlung von chondralen und osteochondralen Defekten in fester oder gelartiger Konsistenz zum Einsatz kommen. Die Implantation ist stets einzeitig möglich und meist in arthroskopischer oder offener Technik durchführbar. Die Evidenz vieler Implantate ist momentan noch relativ gering. Die beste Studienlage bietet momentan die biphasische Kollagenmembran, wobei sich die matrixaugmentierte Knochenmarkstimulation der Mikrofrakturierung überlegen gezeigt hat. Der vorliegende Artikel gibt einen Überblick über die häufigsten momentan verfügbaren Implantate. Darüber hinaus wird auch der aktuelle Stand der Literatur dargestellt.

Abstract

Biomaterials are becoming increasingly more important in reconstructive cartilage surgery. In this context, they should support the formation of a functional cartilage matrix, which is able to fuse with the healthy surrounding chondral structures of the defect and to recruit biomechanical properties comparable to hyaline articular cartilage. Various substrate materials are currently available that are used as monophasic, biphasic or even triphasic framework structures for the treatment of chondral and osteochondral defects with a solid or gel-like consistency. The implantation is invariably possible as a one-step procedure and mostly performed in an arthroscopic or open technique; however, at present the evidence for many implants is still relatively low. The best available evidence is currently from studies with the biphasic collagen membrane, whereby matrix-augmented bone marrow stimulation has proven to be superior to microfracturing. The present article provides a comprehensive overview of the most frequent currently available implants. Furthermore, the current state of the literature on this topic is presented.

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Authors and Affiliations

  1. Abteilung für Sportorthopädie, Arthroskopie und regenerative Gelenkchirurgie, Asklepios Stadtklinik Bad Tölz, Schützenstr. 15, 83646, Bad Tölz, Deutschland

    Peter Cornelius Kreuz

  2. Klinik für Orthopädie und Unfallchirurgie, Campus Lübeck am Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Deutschland

    Justus Gille

  3. Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    Julian Mehl

  4. Klinik für Orthopädie und Traumatologie, Universitätsspital Basel, Spitalstr. 21, 4056, Basel, Schweiz

    Marcus Mumme

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  1. Peter Cornelius Kreuz
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  2. Justus Gille
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  4. Marcus Mumme
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Correspondence to Peter Cornelius Kreuz.

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Interessenkonflikt

P.C. Kreuz, J. Gille, J. Mehl und M. Mumme geben an, dass kein Interessenkonflikt besteht.

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

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H. Madry, Homburg/Saar

P. Niemeyer, München

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Kreuz, P.C., Gille, J., Mehl, J. et al. Zellfreie Biomaterialien zur Knorpelregeneration. Arthroskopie 35, 328–334 (2022). https://doi.org/10.1007/s00142-022-00559-x

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  • DOI: https://doi.org/10.1007/s00142-022-00559-x

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