Möglichkeiten der modernen Gelenkknorpelchirurgie - Mikrofrakturierung, osteochondrale Transplantation

Zusammenfassung

Zur Behandlung von traumatischen Gelenkknorpeldefekten sind unterschiedliche, regenerativ ausgerichtete Therapieverfahren entwickelt worden. Die Auswahl des geeigneten Therapieverfahrens für den einzelnen Patienten hängt ab von einer genauen Patientenevaluation unter Berücksichtigung des Knorpelschadens an sich (u. a. Defektgröße, Defekttiefe) sowie von eventuell vorliegenden Komorbiditäten wie Bandinstabilitäten, Meniskuseinrissen und Achsabweichungen der mechanischen Beinachse oder des Streckapparates. Diese Komorbiditäten müssen im Sinne einer multimodalen Therapie mit korrigiert werden, um ein erfolgreiches Outcome für das jeweilige Knorpeltherapieverfahren zu ermöglichen. Aus der Fülle an vorhandenen regenerativen Knorpeltherapieverfahren soll in diesem Artikel auf die „Knochenmark-stimulierenden Techniken“ und die „osteochondrale Transplantation“ fokussiert werden.

Abstract

Surgical procedures designed to treat focal chondral lesions by regenerating the cartilage surface have been evolving in the last few years. Selecting the proper treatment algorithm for a particular chondral defect depends on careful patient evaluation, including the defect morphology (e.g. defect size, depth) and the recognition of comorbidities such as ligamentous instability, deficient menisci, or misalignment of the mechanical limb axis or extensor mechanism. These comorbidities may need to be treated in conjunction with symptomatic chondral injuries to achieve the desired outcome. Among the various surgical treatment options for focal articular lesions, this article focuses on marrow stimulating techniques and osteochondral transplantation.

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