Zusammenfassung
Das Arthroserisiko des Kniegelenks steigt mit zunehmender Größe eines Knorpelschadens. Eine begleitende Meniskus- oder Bandverletzung erhöht die Gefahr zusätzlich. Um diese Entwicklung aufzuhalten, sollten symptomatische Knorpelschäden biologisch rekonstruiert und Achsfehlstellungen, Band- oder Meniskusverletzungen saniert werden. Beim Erwachsenen hat sich für die biologische Rekonstruktion vollschichtiger Knorpelschäden über 4 cm2 Defektfläche die autologe Chondrozyten-Transplantation (ACT) in einer Reihe teils prospektiv randomisierter Studien als bisher zuverlässigstes Verfahren erwiesen. Zu den Nachteilen der Methode gehören ihre meist nicht minimalinvasive Durchführbarkeit und die häufig auftretende Transplantathyperthrophie. Zur Lösung dieser Probleme wurden verschiedene Biomaterialien für die trägergekoppelte ACT entwickelt. Die von uns verwendete Matrix besteht aus einer abdeckenden Membran und einem zelltragenden Kollagenschwamm. Mit Hilfe spezieller OP-Instrumente ist eine minimalinvasive Implantation möglich, womit eine erhebliche Reduktion der Komorbidität erreicht wurde. Im Tierversuch konnte die Regeneration eines hyalinen Knorpels nachgewiesen werden. Die Ergebnisse der laufenden klinischen Studien mit den unterschiedlichen Biomaterialien bleiben jedoch abzuwarten, bevor deren breite Anwendung für eine trägergekoppelte ACT empfohlen werden kann.
Abstract
The bad risk for an early onset of osteoarthritis in the knee increases with the size of a cartilage defect. A collateral meniscus- or ligament-tear will enforce this hazard in addition. In order to avoid such a development, relevant full-thickness cartilage defects should be reconstructed biologically and attendant meniscus- or ligament-tears as well as varus- or valgus deformities should be treated. A number of studies, including some prospective-randomized trials, have shown that autologous chondrocyte transplantation (ACT) is the most reliable procedure for a surgical treatment of full-thickness cartilage defects larger than 4 cm2 in adults. One disadvantage of ACT is the extensive approach to the joint and often a hypertrophy of the repair tissue. To solve these problems, some different biomaterials for a matrix-assisted ACT have been developed. The scaffold we use has a covering membrane upside and a collagen-sponge carrying the chondrocytes. By means of special surgical instruments a minimally invasive implantation is possible, reducing the side-effects of an extensive approach. Animal studies showed the regeneration of a hyaline cartilage using our described system. However, results of current clinical studies with the different scaffolds must be awaited before an universal application of matrix-assisted ACT can be recommended.
Schlüsselwörter
Gelenkknorpelschäden - biologische Rekonstruktion - matrixgekoppelte autologe Chondrozyten-Transplantation - OP-Technik
Key words
articular cartilage defects - biological reconstruction - matrix-assisted autologous chondrocyte transplantation - operation technique
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Dr. med. J. Fritz
Berufsgenossenschaftliche Unfallklinik
Schnarrenbergstr. 95
72076 Tübingen
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eMail: JFritz18@email.de
