Stellenwert der autologen Chondrozytentransplantation (ACT) in der
                    Behandlung von Knorpelschäden des Kniegelenks – Empfehlungen der AG Klinische
                    Geweberegeneration der DGOU

P. Niemeyer; S. Andereya; P. Angele; A. Ateschrang; M. Aurich; M. Baumann; P. Behrens; U. Bosch; C. Erggelet; S. Fickert; J. Fritz; H. Gebhard; K. Gelse; D. Günther; A. Hoburg; P. Kasten; T. Kolombe; H. Madry; S. Marlovits; N. M. Meenen; P. E. Müller; U. Nöth; J. P. Petersen; M. Pietschmann; W. Richter; B. Rolauffs; K. Rhunau; B. Schewe; A. Steinert; M. R. Steinwachs; G. H. Welsch; W. Zinser; D. Albrecht

doi:10.1055/s-0032-1328207

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2013; 151(1): 38-47
DOI: 10.1055/s-0032-1328207

Knorpel

Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der autologen Chondrozytentransplantation (ACT) in der Behandlung von Knorpelschäden des Kniegelenks – Empfehlungen der AG Klinische Geweberegeneration der DGOU

Autologous Chondrocyte Implantation (ACI) for Cartilage Defects of the Knee: A Guideline by the Working Group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU)

P. Niemeyer

¹Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg

,

S. Andereya

²Orthopädie und Unfallchirurgie, Ortho AC, Aachen

,

P. Angele

³Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg

,

A. Ateschrang

⁴Berufsgenossenschaftliche Unfallklinik Tübingen

,

M. Aurich

⁴Berufsgenossenschaftliche Unfallklinik Tübingen

,

M. Baumann

⁴Berufsgenossenschaftliche Unfallklinik Tübingen

,

P. Behrens

⁵CUNO Orthopädie, Hamburg

,

U. Bosch

⁶Zentrum f. Orthopädische Chirurgie, Sporttraumatologie, INI Hannover

,

C. Erggelet

⁷Center of Biologic Joint Repair, Zürich, Schweiz

,

S. Fickert

⁸Sportopaedicum, Straubing, Berlin, Regensburg, München

,

J. Fritz

⁹Orthopädisches Chirurgisches Centrum, Tübingen

,

H. Gebhard

⁴Berufsgenossenschaftliche Unfallklinik Tübingen

,

K. Gelse

¹⁰Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen

,

D. Günther

¹¹Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH)

,

A. Hoburg

¹²Universitätsmedizin Berlin-Charité, Klinik für Orthopädie, Unfall u. Wiederherstellungschirurgie

,

P. Kasten

¹³Klinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden

,

T. Kolombe

¹⁴Unfallchirurgie / Orthopädie, DRK Krankenhaus Luckenwalde

,

H. Madry

¹⁵Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg

,

S. Marlovits

¹⁶Universitätsklinik für Unfallchirurgie, Medizinische Universität Wien und Austrian Cluster for Tissue Regeneration, Österreich

,

N. M. Meenen

¹⁷Sektion Pädiatrische Sportmedizin, Kinderorthopädie, Altonaer Kinderkrankenhaus Hamburg

,

P. E. Müller

¹⁸Orthopädische Klinik, Ludwig-Maximiliams-Universität München

,

U. Nöth

¹⁹Orthopädische Klinik, König-Ludwig-Haus, Universität Würzburg

,

J. P. Petersen

²⁰Zentrum f. operative Medizin, Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf

,

M. Pietschmann

¹⁸Orthopädische Klinik, Ludwig-Maximiliams-Universität München

,

W. Richter

²¹Forschungszentrum für Experimentelle Orthopädie, Universitätsklinikum Heidelberg

,

B. Rolauffs

⁴Berufsgenossenschaftliche Unfallklinik Tübingen

,

K. Rhunau

²²Zentrum für Orthobiologie und Knorpelregeneration, Schulthess Klinik, Zürich, Schweiz

,

B. Schewe

²³Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken

,

A. Steinert

¹⁹Orthopädische Klinik, König-Ludwig-Haus, Universität Würzburg

,

M. R. Steinwachs

⁸Sportopaedicum, Straubing, Berlin, Regensburg, München

,

G. H. Welsch

¹⁰Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen

,

W. Zinser

²³Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken

,

D. Albrecht

⁴Berufsgenossenschaftliche Unfallklinik Tübingen

› Author Affiliations

Abstract

Zusammenfassung

Die autologe Chondrozytentransplantation oder -implantation (ACT/ACI) stellt ein anerkanntes und etabliertes Verfahren zur Behandlung lokalisiert vollschichtiger Knorpelschäden des Kniegelenks dar. Die vorliegende Übersichtsarbeit der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) beschreibt zunächst die Biologie und Funktionsweise des gesunden Gelenkknorpels, die aktuelle Kenntnislage zu den möglichen Folgen eines primären Knorpelschadens und anschließend den geeigneten Indikationsbereich der ACT. Zusammenfassend besteht vor dem Hintergrund der derzeitigen Evidenzlage die Indikation zur ACT bei symptomatischen Knorpelschäden ab einer Defektgröße von 3–4 cm², bei jungen und sportlich aktiven Patienten ab 2,5 cm². Fortgeschrittene degenerative Gelenkveränderungen stellen die wichtigste Kontraindikation dar. Neben wissenschaftlichen Grundlagen werden die Ergebnisse klinischer Studien, sowie die Vor- und Nachteile der ACT im Rahmen dieser Übersicht dargestellt und diskutiert.

Abstract

Autologous chondrocyte transplantation/implantation (ACT/ACI) is an established and recognised procedure for the treatment of localised full-thickness cartilage defects of the knee. The present review of the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Traumatology (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning potential consequences of primary cartilage lesions and the suitable indication for ACI. Based on current evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than 3–4 cm²; in the case of young and active sports patients at 2.5 cm². Advanced degenerative joint disease is the single most important contraindication. The review gives a concise overview on important scientific background, the results of clinical studies and discusses advantages and disadvantages of ACI.

Schlüsselwörter

Kniegelenk - Knorpelschaden - Knorpelregeneration - Empfehlungen - Arthrose

Key words

knee joint - cartilage defect - cartilage repair - recommendations - osteoarthritis

Full Text

References

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