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DOI: 10.1055/s-2005-872900
Georg Thieme Verlag KG Stuttgart · New York
Operative Therapie von Knorpelschäden des Kniegelenkes
Publication History
Publication Date:
11 October 2005 (online)
Einleitung
Umschriebene Verletzungen und Erkrankungen des hyalinen Gelenkknorpels des Kniegelenkes sind häufig. Das Kniegelenk ist nicht zuletzt aufgrund seiner besonderen Biomechanik (Kraft- versus Formschluss) für Verletzungen prädisponiert. Vor allem aber die veränderten Freizeitgewohnheiten, mit einer Kombination aus geringen Alltagsbelastungen und hohem funktionellen Anspruch bei sportlichen Aktivitäten, haben zu einer Zunahme chondraler und osteochondraler Läsionen geführt.
In arthroskopischen Studien zeigten über 50 % der 30 000 untersuchten Patienten krankhafte Veränderungen des Gelenkknorpels
In arthroskopischen Studien wurden Knorpelläsionen in über 50 % der Kniegelenke nachgewiesen. |
Die operativen Behandlungsmöglichkeiten sind in den letzten Jahren vor allem durch die zellbasierten Transplantationsverfahren erweitert worden. Der rationelle Einsatz operativ-therapeutischer Verfahren zur Behandlung von Knorpeldefekten erfordert eine Orientierung an den Ursachen, der klinischen Symptomatik und dem möglichen Spontanverlauf der Erkrankung.
Literatur
- 1 Curl W W, Krome J, Gordon E S. et al . Cartilage injuries: a review of 31516 knee arthroscopies. Am J Sports Med. 2004; 32 211-215
- 2 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1000 knee arthroscopies. Arthroscopy. 2002; 18 730-734
- 3 Hunziker E B, Quinn T M. Surgical removal of articular cartilage leads to loss of chondrocytes from cartilage bordering the wound edge. JBJS. 2003; 85-A (Suppl 2) 85-92
- 4 Koch S, Kampen W U, Laprell H. Cartilage and bone morphology in osteochondritis dissecans. Knee Surg Sports Traumatol Arthrosc. 1997; 5 42-45
- 5 Young A, Smith M M. et al . Regional assessment of articular cartilage gene expression and small proteoglycan metabolism in an animal model of osteoarthritis. Arthritis Res Ther. 2005; 7 852-861
- 6 Shelbourne K D, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee. J Bone Joint Surg. 2003; 85-A (Suppl 2) 8-16
- 7 Messner K, Maletius W. 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. 1996; 67 165-168
- 8 Grande D A, Pitman M I, Peterson L. et al . The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation. J Orthop Res. 1989; 7 208-218
- 9 Ghadially F N, Thomas I, Oryschak A F. et al . Long-term results of superficial defects in articular cartilage: a scanning electron-microscope study. J Pathol. 1977; 121 213-217
- 10 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
- 11 Brittberg M, Winalski C S. Evaluation of cartilage injuries and repair. J Bone Joint Surg. 2003; 85-A (Suppl 2) 58-69
- 12 Oakley S P, Portek I, Szomor Z. et al . Poor accuracy and interobserver reliability of knee arthroscopy measurements are improved by the use of variable angle elongated probes. Ann Rheum Dis. 2002; 61 540-543
- 13 Kawahara Y, Uetani M, Nakahara N. et al . Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee. Correlation of MR and arthroscopic findings. Acta Radiol. 1998; 39 120-125
- 14 Jackson R W, Marans H J, Silver R S. Arthroscopic treatment of degenerative arthritis of the knee. J Bone Joint Surg. 1988; 70 A 332
- 15 Hubbard M JS. Articular debridement versus washout for degeneration of medial femoral condyle. J Bone Joint Surg. 1996; 78 217-219
- 16 Kim H KW, Schmid A, Schmid F. Results after cartilage shaving studied by electron microscopy. Am J Sports Med. 1991; 15 386-387
- 17 Moseley J B, O'Malley K. et al . A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002; 347 81-88
- 18 Pridie K H. A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg. 1959; 41 618-619
- 19 Kim H WK, Moran M, Keeley F W. et al . The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits. J Bone Joint Surg. 1991; 73-A 1301-1315
- 20 Steadman J R, Rodkey W G, Briggs K K. et al . Die Technik der Mikrofrakturierung zur Behandlung von kompletten Knorpeldefekten im Kniegelenk. Orthopäde. 1999; 28 26-32
- 21 Homminga G N, Bulstra S K, Bouwmeester P SM. et al . Perichondrial grafting for cartilage lesions of the knee. J Bone Joint Surg. 1990; 72 1003-1007
- 22 Bouwmeester S J, Beckers J M, Kuijer R. et al . Long-term results of rib perichondrial grafts for repair of cartilage defects in the human knee. Internat Orthop. 1997; 21 313-317
- 23 Bruns J, Steinhagen J. Treatment of deep hyaline cartilage defects with autologous perichondrial grafts. Int J Sports Med. 2003; 24 382-388
- 24 Kwan M K, Coutts R D, Woo S LY. et al . Morphological and biomechanical evaluations of neocartilage from the repair of full-thickness articular cartilage defects using rib perichondrium autografts: a long-term study. J Biomech. 1989; 22 921-930
- 25 Wagner H. Operative Behandlung der Osteochondrosis dissecans des Kniegelenkes. Z Orthopädie. 1964; 50 62-64
- 26 Garrett J C. Osteochondral allografts. Instr Course lect. 1993; 42 355-358
- 27 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
- 28 LaPrade R F, Botker J C. Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy. 2004; 20 69-73
- 29 Brittberg M, Lindahl A, Nilsson A. et al . Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994; 331 889-895
- 30 Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg. 2003; 85 (Suppl 2) 17-24
- 31 Bartlett W, Gooding C R, Carrington R WJ. et al . Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft: a preliminary report. J Bone Joint Surg. 2005; 87 330-332
- 32 Schultz W, Gobel D. Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques. Knee Surg Sports Traumatol Arthrosc. 1999; 7 29-36
- 33 Behrens P, Bosch U, Bruns J. et al . Indikations- und Durchführungsempfehlungen der Arbeitsgemeinschaft „Geweberegeneration und Gewebeersatz“ zur Autologen Chondrozytentransplantation. Z Orthop. 2004; 142 529-539
- 34 Salter R B, Simmonds D F, Malcolm B W. et al . The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. J Bone Joint Surg. 1980; 62 1232-1251
- 35 Hangody L, Kish G, Kárpáti Z. et al . Arthroscopic autogenous osteochondral mosaicplasty - a multicentric, comparative, prospective study. Index Traumat Sport. 1998; 5 3-9
- 36 Micheli L J, Browne J E, Erggelet C. et al . Autologous chondrocyte implantation of the knee: multicentre experience and minimum 3-year follow-up. Clin J Sport Med. 2001; 11 223-228
- 37 Knutsen G, Engebretsen L, Ludvigsten T C. et al . Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg. 2004; 86 455-464
- 38 Horas U, Pelinkovic D, Herr G. et al . Autologous chondrocytes implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint: a prospective, comparative trial. J Bone Joint Surg. 2003; 85 185-192
- 39 Bentley G, Briant 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. 2003; 85 223-230
Dr. Jörg Steinhagen
Klinik und Poliklinik für Orthopädie · Universitätsklinikum Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg