Zusammenfassung
Für die biologische Rekonstruktion vollschichtiger Knorpelschäden des Kniegelenks in Folge eines Traumas oder einer Osteochondrosis dissecans stehen mittlerweile verschiedene Methoden zur Verfügung. In einer Reihe teils prospektiv randomisierter Studien hat sich die autologe Chondrozyten-Transplantation (ACT) beim Erwachsenen als bisher zuverlässigstes Rekonstruktionsverfahren bei Defektgrößen ab 4 cm2 erwiesen. Aufgrund dieser Ergebnisse scheint die ACT auch von volkswirtschaftlicher Bedeutung zu sein, da gerade bei größeren Knorpelschäden das Arthroserisiko im Spontanverlauf oder nach Anwendung ungeeigneter Methoden erheblich zunimmt.Die Summe der bis heute zur ACT veröffentlichten grundlagenwissenschaftlichen, tierexperimentellen und klinischen Studien deutet allerdings auch darauf hin, dass der therapeutische Erfolg dieser Methode von einer Reihe, zum Teil sehr unterschiedlicher, Einzelfaktoren abhängt. In der vorliegenden Übersichtsarbeit der Arbeitsgemeinschaft „Geweberegeneration und Gewebeersatz” der DGU und DGOOC werden daher die bisher erkannten Einflussgrößen der verschiedenen Verfahrensanteile dargestellt, um hieraus geeignete Indikations- und Durchführungsempfehlungen für die ACT abzuleiten.
Abstract
For the treatment of full-thickness articular cartilage lesions of the knee joint, as a result of trauma or osteochondritis dissecans, a variety of biological reconstruction techniques have been developed. Different studies, some of which were performed as randomised, prospective clinical studies, showed that the autologous chondrocyte transplantation (ACT) provides the most satisfying and reliable method of cartilage reconstruction in the adult when applied to defects exceeding 4 cm2 . Based on these results, ACT seems to be of economic benefit, as the risk of developing osteoarthritis correlates significantly with the size of the cartilage defect, when not treated properly and in time.Surveying the studies on basic scientific aspects of ACT, cartilage defect animal models and clinical studies, it can be concluded that clinical results of ACT depend on a variety of factors. In this review, published by the joined advisory board of the German Societies of Traumatology (DGU) and Orthopaedic Surgery (DGOOC), we summarize the current knowledge available and the state of the art concerning ACT. Especially we discuss the advantages of different procedures, methods for treating knee cartilage defects and factors that influence the outcome of the different treatment regimens, with the aim to develop guidelines for the correct indication and application of the ACT.
Schlüsselwörter
Knorpelschaden - biologische Rekonstruktion - autologe Chondrozyten-Transplantation - Indikation - Durchführung
Key words
Articular cartilage defects - biological reconstruction - autologous chondrocyte transplantation - indication - application
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Univ-Prof. Dr. med. Fritz-Uwe NiethardKorrespondierender Autor für die DGOOC
Orthopädische Universitätsklinik der RWTH-Aachen
Pauwelsstr. 30
52704 Aachen
Phone: 02 41/8 08-94 10
Fax: 02 41/8 08-24 53
Univ-Prof. Dr. med. Kuno WeiseKorrespondierender Autor für die DGU
Berufsgenossenschaftliche Unfallklinik · Eberhard-Karls-Universität Tübingen
Schnarrenbergstr. 95
72076 Tübingen
Phone: 0 70 71/6 06-10 01
Fax: 0 70 71/6 06-10 02