Zusammenfassung
Zur Behandlung von lokalen Knorpeldefekten stehen unterschiedliche Verfahren zur Auswahl, wobei es bezüglich der Therapieart bis heute keine einheitliche Meinung gibt. Grundsätzlich werden Therapieansätze mit oder ohne Chondrozytentransplantation unterschieden, die weiter in knochenmarkstimulierende Techniken und Transplantationstechniken differenziert werden können.
Das am häufigsten verwendete Verfahren ist die Mikrofrakturierung, bei der es durch Eröffnung des subchondralen Knochens zur Einblutung in den Defektbereich kommt. In den letzten Jahren ist diese Technik durch die autogene matrixinduzierte Chondrogenese (AMIC) erweitert worden. Die Verwendung einer den „Blut-Clot“ stabilisierenden Matrix und die Anwendung des Fibrinklebers machen es hierbei möglich, auch größere Defekte zu behandeln. Weitere Vorteile gegenüber den autologen Chondrozytentransplantationsverfahren sind die Kostenreduktion und die einzeitige sofortige Behandlung von Knorpeldefekten ohne zusätzliche Knorpelbiopsie für eine Zellkultivierung. Matrix und zusätzliche Wachstumsfaktoren werden auch künftig weiterentwickelt. Der vorliegende Artikel gibt einen Überblick über die Geschichte der Mikrofrakturierung und die aktuell zur Verfügung stehenden neuen Verfahren.
Abstract
Various surgical techniques are now available for the treatment of local chondral defects, but there is still no general agreement on the type of treatments indicated. The treatment options are divided basically into procedures with and without chondrocyte transplantation, the latter being subdivided into such procedures as marrow stimulation and transplantation.
The most common surgical technique used in the treatment of local chondral defects is microfracturing, in which subchondral bone spaces are opened so that a blood clot fills the defect. In recent years this technique has been improved by the addition of autologous matrix-induced chondrogenesis (AMIC). The application of a matrix for better containment and of fibrin glue has made it possible to treat larger chondral lesions. Further advantages over autologous chondrocyte implantation are the lower cost and the single-step immediate treatment of the cartilage defects, since an additional cartilage biopsy for cell culture is not needed. Further development of matrices and growth factors will continue in the future. The present article gives an overview of the development of microfracture, the indications for it, and the current therapeutic alternatives in cartilage repair.
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Behrens, P., Kreuz, P. Knochenmarkstimulierende Techniken zur Knorpeldefektbehandlung: gestern, heute und morgen. Trauma Berufskrankh 9, 242–245 (2007). https://doi.org/10.1007/s10039-007-1304-6
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DOI: https://doi.org/10.1007/s10039-007-1304-6
Schlüsselwörter
- Knorpeldefektbehandlung
- Mikrofrakturierung
- Chondrozytentransplantation
- Autologe matrixinduzierte Chondrogenese
- AMIC