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Z Orthop Ihre Grenzgeb 2004; 142(5): 540-545
DOI: 10.1055/s-2004-832362
Knorpelersatz

© Georg Thieme Verlag Stuttgart · New York

Meniskusersatz: Aktuelle Aspekte auf dem Gebiet des Tissue engineering

Meniscus Replacement: Current Aspects in Tissue EngineeringR. Müller-Rath1 , T. Mumme1 , O. Miltner1 , S. Andereya1 , U. Schneider1
  • 1Orthopädische Klinik, Universitätsklinikum Aachen
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Publication History

Publication Date:
07 October 2004 (online)

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Zusammenfassung

Tissue engineering eröffnet neue Möglichkeiten für die Meniskusheilung und den Meniskusersatz. Auf diesem Gebiet werden verschiedene Ansätze verfolgt, um ein Implantat für den Meniskusersatz durch die Kombination aus einem Matrixgerüst, Zellen und spezifischen Stimuli zu generieren. Meniskusersatz durch azelluläre Matrizes: Eine Matrix für den Meniskusersatz muss hohen biomechanischen Ansprüchen gerecht werden. Hierbei stellen neben der Implantatgeometrie die Materialeigenschaften und eine sichere intraartikuläre Fixation die Voraussetzung für die Implantatfunktion dar. Ein azelluläres Kollagen-Gerüst wird als partieller Meniskusersatz bereits klinisch eingesetzt. Außerdem sind resorbierbare Polymere sowie ein Implantat aus Dünndarmsubmukosa im Tierversuch erprobt worden. Nach Implantation werden diese Matrizes von Zellen besiedelt und unterliegen einem Remodeling. Die Bildung eines fibrokartilaginären Regeneratgewebes wurde beobachtet. Die biomechanische Qualität von Implantaten und deren Auswirkungen auf den Knorpelschutz müssen noch weiter untersucht werden. Zelluläre Besiedelung von Matrizes für den Meniskusersatz: Eine zelluläre Besiedelung von Matrizes in vitro könnte zu einer Verbesserung der biologischen und biomechanischen Implantateigenschaften führen. Allerdings ist der hierfür ideale Zelltyp noch nicht definiert. Autologe Meniskuszellen, artikuläre Chondrozyten und mesenchymale Stammzellen stellen mögliche zelluläre Quellen dar. Zusätzliche Stimuli, wie Zytokine und mechanische Kräfte, sowie gentechnische Verfahren bieten Möglichkeiten, die Qualität eines Ersatzgewebes weiter zu steigern.

Abstract

Tissue engineering offers new opportunities for meniscus repair and replacement. In this field different approaches are being studied to genererate a meniscus subsitute by a combination of a matrix scaffold, cells and specific stimuli. Meniscus replacement by acelluar matrices: For meniscus replacement the matrix material has to meet high biomechanical demands. Besides implant geometry, the material properties and a secure intraarticular attachment are important preconditions for implant function. A collagen scaffold has already been applied clinically for partial meniscus replacement. Scaffolds made of synthetic, bioabsorbable polymers and small intestine submucosa have been employed in animal studies. Following implantation, matrices are invaded by cells and undergo a process of remodeling. Formation of fibrocartilage repair tissue has been observerd. The biomechanical quality of implants and their effect on cartilage preservation have to be studied further. Cellular seeding of matrices for mensicus replacement: Advanced biological and biomechanical implant quality might be achieved by seeding matrices with cells in vitro. However, the ideal type of cell for this purpose has not yet been identified. Autologous mensicus cells, articular chondrocytes and mesenchymal stem cells represent possible cellular sources. Additional stimuli, such as cytokines and mechanical forces, and techniques of genetic engineering might further contribute to enhance the quality of engineered tissue.

Schlüsselwörter

Meniskus - Tissue engineering - Meniskusersatz - Matrix - Zelle

Key words

Meniscus - tissue engineering - meniscus replacement - matrix scaffold - cell

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Dr. med. Ralf Müller-Rath

Orthopädische Klinik · Universitätsklinikum Aachen

Pauwelsstraße 30

52074 Aachen

Phone: 02 41-80-8 55 85

Fax: 02 41-80-8 25 07

Email: rmueller-rath@ukaachen.de