RSS-Feed abonnieren
DOI: 10.1055/s-2005-865959
Georg Thieme Verlag KG Stuttgart · New York
Möglichkeiten der modernen Gelenkknorpelchirurgie - Mikrofrakturierung, osteochondrale Transplantation
Surgical Treatment Options for Focal Articular Lesions - Microfracture, Osteochondral TransplantationPublikationsverlauf
Publikationsdatum:
10. Oktober 2005 (online)
![](https://www.thieme-connect.de/media/trauma/200505/lookinside/thumbnails/10.1055-s-2005-865959-1.jpg)
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.
Literatur
- 1 Bentley G, Biant L C, Carrington R W. et al . A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg [Br]. 2003; 85 223-230
- 2 Bert J M. Role of abrasion arthroplasty and débridement in the management of osteoarthritis of the knee. Rheum Dis Clin North Am. 1993; 19 725-739
- 3 Brittberg M, Tallheden T, Sjogren-Jansson B. et al . Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop. 2001; 391 (Suppl) S337-S348
- 4 Brittberg M, Winalski C S. Evaluation of cartilage injuries and repair. J Bone Joint Surg [Am]. 2003; 85 (Suppl 2) 58-69
- 5 Cain E L, Clancy W G. Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 2001; 20 321-342
- 6 Chow J C, Hantes M E, Houle J B. et al . Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study. Arthroscopy. 2004; 20 681-690
- 7 Curl W W, Krome J, Gordon E S. et al . Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997; 13 456-460
- 8 Dorotka R, Windberger U, Macfelda K. et al . Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials. 2005; 26 3617-3629
- 9 Duchow J, Hess T, Kohn D. Primary stability of press-fit-implanted osteochondral grafts. Influence of graft size, repeated insertion, and harvesting technique. Am J Sports Med. 2000; 28 24-27
- 10 Frisbie D D, Oxford J T, Southwood L. et al . Early events in cartilage repair after subchondral bone microfracture. Clin Orthop. 2003; 407 215-227
- 11 Gill T J, McCulloch P C, Glasson S S. et al . Chondral defect repair after the microfracture procedure. Am J Sports Med. 2005; 33 680-685
- 12 Goymann V. Abrasion arthroplasty. Orthopäde. 1999; 28 11-18
- 13 Hangody L, Feczko P, Bartha L. et al . Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop. 2001; 391 (Suppl) S328-S336
- 14 Hangody L, Fules P. 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]. 2003; 85 (Suppl 2) 25-32
- 15 Hjelle K, Solheim E, Strand T. et al . Articular cartilage defects in 1000 knee arthroscopies. Arthroscopy. 2002; 18 730-734
- 16 Horas U, Pelinkovic D, Herr G. et al . Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg [Am]. 2003; 85 185-192
- 17 Hunt S A, Jazrawi L M, Sherman O H. Arthroscopic management of osteoarthritis of the knee. J Am Acad Orthop Surg. 2002; 10 356-363
- 18 Hunter W. Of the structure and diseases of articulating cartilages. Phil Trans R Soc Lond. 1743; 42 514-522
- 19 Hunziker E B. Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthritis Cartilage. 2002; 10 432-463
- 20 Jakob R P, Franz T, Gautier E. et al . Autologous osteochondral grafting in the knee: indication, results, and reflections. Clin Orthop. 2002; 401 170-184
- 21 Johnson L L. Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status. Arthroscopy. 1986; 2 54-69
- 22 Johnson L L. Arthroscopic abrasion arthroplasty: a review. Clin Orthop. 2001; 391 (Suppl) S306-S317
- 23 Kish G, Modis L, Hangody L. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results. Clin Sports Med. 1999; 18 45-66, vi
- 24 Knutsen G, Engebretsen L, Ludvigsen T C. et al . Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg [Am]. 2004; 86 455-464
- 25 Mankin H J. The response of articular cartilage to mechanical injury. J Bone Joint Surg [Am]. 1982; 64 460-466
- 26 Matsusue Y, Yamamuro T, Hama H. Arthroscopic multiple osteochondral transplantation to the chondral defect in the knee associated with anterior cruciate ligament disruption. Arthroscopy. 1993; 9 318-321
- 27 Meachim G, Roberts C. Repair of the joint surface from subarticular tissue in the rabbit knee. J Anat. 1971; 109 317-327
- 28 Messner K. The longterm prognosis for severe damage to weight-bearing cartilage in the knee. A 14 year clinical and radiographic follow-up in 28 young athelets. Acta Orthop Scand. 1996; 67 165-168
- 29 Messner K, Gillquist J. Cartilage repair. A critical review. Acta Orthop Scand. 1996; 67 523-529
- 30 Mitchell N, Shepard N. The resurfacing of adult rabbit articular cartilage by multiple perforations through the subchondral bone. J Bone Joint Surg [Am]. 1976; 58 230-233
- 31 Noyes F R, Bassett R W, Grood E S. et al . Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg [Am]. 1980; 62 687-695 757
- 32 Passler H H. Microfracture for treatment of cartilage defects. Zentralbl Chir. 2000; 125 500-504
- 33 Pridie K H. A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg [Br]. 1959; 41 618-619
- 34 Rand J A, Ritts G D. Abrasion arthroplasty as a salvage for failed upper tibial osteotomy. J Arthroplasty. 1989; 4 S45-48
- 35 Rudd R G, Visco D M, Kincaid S A. et al . The effects of beveling the margins of articular cartilage defects in immature dogs. Vet Surg. 1987; 16 378-383
- 36 Schneider U, Breusch S J, von der Mark K. Current status of autologous chondrocyte transplantation. Z Orthop Ihre Grenzgeb. 1999; 137 386-392
- 37 Shelbourne K D, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg [Am]. 2003; 85 (Suppl 2) 8-16
- 38 Simonian P T, Sussmann P S, Wickiewicz T L. et al . Contact pressures at osteochondral donor sites in the knee. Am J Sports Med. 1998; 26 491-494
- 39 Singh S, Lee C C, Tay B K. Results of arthroscopic abrasion arthroplasty in osteoarthritis of the knee joint. Singapore Med J. 1991; 32 34-37
- 40 Sledge S L. Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med. 2001; 20 365-377
- 41 Steadman J R, Briggs K K, Rodrigo J J. et al . Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003; 19 477-484
- 42 Whiteside R A, Bryant J T, Jakob R P. et al . Short-term load bearing capacity of osteochondral autografts implanted by the mosaicplasty technique: an in vitro porcine model. J Biomech. 2003; 36 1203-1208
- 43 Wolfe F, Lane N E. The longterm outcome of osteoarthritis: rates and predictors of joint space narrowing in symptomatic patients with knee osteoarthritis. J Rheumatol. 2002; 29 139-146
- 44 Wu J Z, Herzog W, Hasler E M. Inadequate placement of osteochondral plugs may induce abnormal stress-strain distributions in articular cartilage - finite element simulations. Med Eng Phys. 2002; 24 85-97
- 45 Yamashita F, Sakakida K, Suzu F. et al . The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee. Clin Orthop. 1985; 201 43-50
Peter Angele
Abteilung für Unfallchirurgie
Universitätsklinik Regensburg
Franz-Josef-Strauß-Allee 11
93053 Regensburg
Telefon: 0941/9446805
Fax: 0941/9446806
eMail: peter.angele@klinik.uni-regensburg.de