Skip to main content
Log in

Knochenmarkstimulierende Techniken zur Knorpeldefektbehandlung: gestern, heute und morgen

Bone marrow-stimulating techniques for treatment of cartilaginous defects: yesterday, today and tomorrow

  • Leitthema
  • Published:
Trauma und Berufskrankheit

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.

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
Abb. 4
Abb. 5

Literaturverzeichnis

  1. Behrens P (2005) Matrixgekoppelte Mikrofrakturierung. Arthroskopie 18: 193–197

    Article  Google Scholar 

  2. Benya PD, Shaffer JD (1982) Dedifferentiated chondrocytes reexpress the differentiated collagen phenotype when cultured in agarose gels. Cell 30: 215–224

    Article  PubMed  CAS  Google Scholar 

  3. Bojanic I, Ivkovic A, Boric I (2006) Arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts. Knee Surg Sports Traumatol Arthrosc 14: 491–496

    Article  PubMed  Google Scholar 

  4. Buckwalter JA, Mankin HJ (1997) Articular cartilage – Part II. Degeneration and osteoarthrosis, repair, regeneration, and transplantation. J Bone Joint Surg Am 79: 612–633

    Google Scholar 

  5. Erggelet Ch (2007) Die matrixaugmentierte Knochenmarkstimulation. Leading Opinions Orthopädie 3: 36–38

    Google Scholar 

  6. Gobbi A, Francisco RA, Lubowitz JH et al. (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22: 1085–1092

    Article  PubMed  Google Scholar 

  7. Huang Q, Goh JC, Hutmacher DW, Lee EHL (2000) In vivo mesenchymal cell recruitment by a scaffold loaded with transforming growth factor beta and the potential for in situ chondrogenesis. Tissue Eng 8: 469–482

    Article  Google Scholar 

  8. Insall J (1974) The Pridie debridement operation for osteoarthritis of the knee. Clin Orthop Relat Res101: 61–67

    Google Scholar 

  9. 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 

  10. Kramer J, Bohrnsen F, Lindner U et al. (2006) In vivo matrix-guided human mesenchymal stem cells. Mol Life Sci 63: 616–626

    Article  CAS  Google Scholar 

  11. Kreuz PC, Erggelet C, Steinwachs MR et al. (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22: 1180–1186

    Article  PubMed  Google Scholar 

  12. Kreuz PC, Steinwachs MR, Erggelet C 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 

  13. Martin JA, Buckwalter JA (2003) The role of chondrocyte senescence in the pathogenesis of osteoarthritis and in limiting cartilage repair. J Bone Joint Surg Am 85: 106–110

    PubMed  Google Scholar 

  14. Messner K, Maletius W (1996) The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand 67: 165–168

    Article  PubMed  CAS  Google Scholar 

  15. Miller BS, Steadman JR, Briggs KK et al. (2004) Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 17: 13–17

    PubMed  Google Scholar 

  16. Mithoefer K, Williams RJ 3rd, Warren RF et al. (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87: 1911–1920

    Article  PubMed  Google Scholar 

  17. Peterson L, Minas T, Brittberg M et al. (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop 374: 212–234

    Article  PubMed  Google Scholar 

  18. Pridie KH (1959) A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg Br 41: 618–619

    Google Scholar 

  19. Siebold R, Lichtenberg S, Habermeyer P (2003) Combination of microfracture and periosteal-flap for the treatment of focal full thickness articular cartilage lesions of the shoulder: a prospective study. Knee Surg Sports Traumatol Arthrosc 11: 183–189

    PubMed  CAS  Google Scholar 

  20. Steadman JR, Briggs KK, Rodrigo JJ et al. (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19: 477–484

    Article  PubMed  Google Scholar 

  21. Steadman JR, Rodkey WG, Briggs KK (2002) Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation and outcomes. J Knee Surg 15: 170–176

    PubMed  Google Scholar 

  22. Takao M, Ochi M, Naito K et al. (2003) Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome. Arthroscopy 19: 524–530

    Article  PubMed  Google Scholar 

  23. Valentin B (1991) Geschichte der Orthopädie. Georg Thieme, Stuttgart, S 147–148

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Beratungs- und Referententätigkeit Geistlich Pharma AG, Schweiz

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P. Behrens.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-007-1304-6

Schlüsselwörter

Keywords

Navigation