Skip to main content
Log in

Der Knorpeldefekt am Kniegelenk

Differentialindikation etablierter Therapieverfahren

Articular cartilage defects of the knee

Differentiated indications for established surgical procedures

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Vollschichtige Knorpeldefekte des Kniegelenks, z. B. als Folge eines Traumas, weisen vor allem beim Erwachsenen eine geringe Fähigkeit zur Selbstheilung auf und führen sekundär häufig zu einer altersvorauseilenden Abnutzung des betroffenen Gelenks. Tierexperimentelle und klinische Studien konnten zeigen, dass die frühzeitige operative Sanierung umschriebener und klinisch symptomatischer Knorpelschäden des Knies anderen therapeutischen Optionen überlegen ist. Deshalb empfiehlt sich dieses Vorgehen, um eine fortschreitende Knorpeldegeneration infolge primärer Knorpelschäden zu verhindern oder zumindest zu verzögern. Derzeit stehen dafür verschiedene Verfahren zur Verfügung, die für unterschiedliche Indikationen mehr oder weniger bzw. auch nicht geeignet sind. Ferner sind neben der Behandlung des eigentlichen Gelenkknorpeldefekts auch Begleitschäden wie Bandrupturen, Meniskusläsionen und/oder pathologische Achsabweichungen zeitnah zu sanieren, um das Ergebnis der Knorpelrekonstruktion nicht zu gefährden. Bei Berücksichtigung der jeweils geeigneten Indikation sind die bisherigen klinischen Ergebnisse durchaus vielversprechend. Zukünftige Entwicklungen, insbesondere auf dem Gebiet der Biomaterialien, lassen weitere Vereinfachungen in der Applikation und erweiterte Indikationsspektren erwarten.

Abstract

Full-thickness articular cartilage defects of the knee, e.g. as the result of trauma, have a poor self-healing capacity, especially in adults. Such defects frequently lead to premature degeneration of the affected joint. Experimental animal studies and clinical studies have shown that early biological reconstruction of circumscribed and clinically symptomatic cartilage lesions of the knee is superior to other treatment options. This procedure is therefore recommended in order to avoid or at least delay the degenerative process. Various techniques are currently available for this purpose, and for each there are indications for which they are more or less suitable or even not at all suitable. In addition, as well as the treatment of the actual cartilage defect in the joint, concomitant lesions such as ligament tears, meniscus lesions and/or pathologic axial deviations need to be corrected as soon as possible, to avoid prejudicing the result of the cartilage reconstruction. With due consideration for the suitable indications in each case the clinical results so far have been consistently promising. Future developments, especially in the biomaterial sector, lead us to expect much simper application and extended ranges of indications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3

Literaturverzeichnis

  1. Aroen A, Loken S, Heir S et al. (2004) Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 32: 211–15

    Article  PubMed  Google Scholar 

  2. Behrens P, Bitter T, Kurz B, Russlies M (2006) Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)-5-year follow-up. Knee 13: 194–202

    Article  PubMed  Google Scholar 

  3. Behrens P, Bosch U, Bruns J et al. (2004) Indikations- und Durchführungsempfehlungen der Arbeitsgemeinschaft „Geweberegeneration und Gewebeersatz“ der DGU & DGOOC zur Autologen Chondrozyten-Transplantation (ACT). Z Orthop Ihre Grenzgeb 142: 529–539

    Article  PubMed  CAS  Google Scholar 

  4. 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  PubMed  CAS  Google Scholar 

  5. Curl WW, Krome J, Gordon ES et al. (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13: 456–60

    Article  PubMed  CAS  Google Scholar 

  6. Engelhardt M (2003) Epidemiology of osteoarthritis in Western Europe. Dtsch Z Sportmed 54: 171–75

    Google Scholar 

  7. Fritz J, Eichhorn HJ, Aicher WK (2003) Praxisleitfaden der Knorpelreparatur. Springer, Berlin Heidelberg

  8. Fritz J, Gaissmaier C, Schewe B, Weise K (2005) Stellenwert und Technik der Autologen Chondrozyten-Transplantation. Zentralbl Chir 130: 327–332

    Article  PubMed  CAS  Google Scholar 

  9. Gaissmaier C, Fritz J, Mollenhauer J et al. (2003) Verlauf klinisch symptomatischer Knorpelschäden des Kniegelenks: Ergebnisse ohne und mit biologischer Rekonstruktion. Dtsch Arztebl 100: A 2448–2453

    Google Scholar 

  10. Gaissmaier C, Fritz J, Schewe B et al. (2006) Cartilage defects: epidemiology and natural history. Osteo Trauma Care 14: 188–194

    Article  Google Scholar 

  11. Gaissmaier C, Fritz J, Schewe B et al. (2006) Development of NOVOCART® 3D, a novel system of scaffold augmented transplantation of autologous chondrocytes. In: Zanasi S, Brittberg M, Marcacci M (eds) Basic Science, Clinical Repair and Reconstruction of Articular Cartilage Defects: Current Status and Prospects (vol 1). Timeo Editore, pp 573–585

  12. Gooding CR, Bartlett W, Bentley G et al. (2006) A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered. Knee 13: 203–210

    Article  PubMed  CAS  Google Scholar 

  13. 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 

  14. 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 (Suppl 2) 85: 25–32

    Google Scholar 

  15. Henderson I, Lavigne P, Valenzuela H, Oakes B (2007) Autologous chondrocyte implantation: superior biologic properties of hyaline cartilage repairs. Clin Orthop Relat Res 455: 253–261

    Article  PubMed  Google Scholar 

  16. Hjelle K, Solheim E, Strand T et al. (2002) Articular cartilage defects in 1.000 knee arthroscopies. Arthroscopy 18: 730–34

    Article  PubMed  Google Scholar 

  17. Hunziker EB (2002) Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthritis Cartilage 10: 432–463

    Article  PubMed  CAS  Google Scholar 

  18. Jacobsson L, Lindgarde F, Manthorpe R (1989) The commonest rheumatic complaints of over six weeks duration in a twelve-month period in a defined Swedish population. Prevalences and relationships. Scand J Rheumatol 18: 353–60

    PubMed  CAS  Google Scholar 

  19. Knutsen G, Drogset JO, Engebretsen L et al. (2006) Autologous chondrocyte implantation compared with microfracture in the knee (five year follow up). 6th Symposium of the International Cartilage Repair Society. San Diego, CA, USA, January 8–11

  20. Knutsen G, Engebretsen L, Ludvigsen TC et al. (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86: 455–464

    PubMed  Google Scholar 

  21. Kreuz PC, Steinwachs M, Krause SJ et al. (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 14: 1119–1125

    Article  PubMed  CAS  Google Scholar 

  22. Otte P (2000) Physiologie der Gelenkerhaltung. In: Otte P (Hrsg) Der Arthrose-Prozess. Gelenkerhaltung – Gefährdung – Destruktion. Teil 1: Osteochondrale Strukturen. Novartis Pharma, Nürnberg, S 7–192

    Google Scholar 

  23. Peterson L, Brittberg M, Kiviranta I et al. (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30: 2–12

    PubMed  Google Scholar 

  24. Van Saase JL, van Romunde LK, Cats A et al. (1989) Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 48: 271–80

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Geschäftliche Beziehungen zur Aesculap AG&CoKG

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Fritz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fritz, J., Gaissmaier, C., Schewe, B. et al. Der Knorpeldefekt am Kniegelenk. Trauma Berufskrankh 9, 246–251 (2007). https://doi.org/10.1007/s10039-007-1303-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-007-1303-7

Schlüsselwörter

Keywords

Navigation