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Aktuelle Traumatol 2005; 35(5): 255-259
DOI: 10.1055/s-2005-865959
Schwerpunktthema

Georg Thieme Verlag KG Stuttgart · New York

Möglichkeiten der modernen Gelenkknorpelchirurgie - Mikrofrakturierung, osteochondrale Transplantation

Surgical Treatment Options for Focal Articular Lesions - Microfracture, Osteochondral TransplantationP. Angele1 , J. Zellner1 , C. Englert1 , M. Nerlich1
  • 1Abteilung für Unfallchirurgie, Universitätsklinik Regensburg
Further Information

Publication History

Publication Date:
10 October 2005 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Brittberg M, Winalski C S. Evaluation of cartilage injuries and repair.  J Bone Joint Surg [Am]. 2003;  85 (Suppl 2) 58-69
    PubMedGoogle Scholar
  • 5 Cain E L, Clancy W G. Treatment algorithm for osteochondral injuries of the knee.  Clin Sports Med. 2001;  20 321-342
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Goymann V. Abrasion arthroplasty.  Orthopäde. 1999;  28 11-18
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Hjelle K, Solheim E, Strand T. et al . Articular cartilage defects in 1000 knee arthroscopies.  Arthroscopy. 2002;  18 730-734
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 18 Hunter W. Of the structure and diseases of articulating cartilages.  Phil Trans R Soc Lond. 1743;  42 514-522
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 21 Johnson L L. Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status.  Arthroscopy. 1986;  2 54-69
    CrossrefPubMedGoogle Scholar
  • 22 Johnson L L. Arthroscopic abrasion arthroplasty: a review.  Clin Orthop. 2001;  391 (Suppl) S306-S317
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 25 Mankin H J. The response of articular cartilage to mechanical injury.  J Bone Joint Surg [Am]. 1982;  64 460-466
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 27 Meachim G, Roberts C. Repair of the joint surface from subarticular tissue in the rabbit knee.  J Anat. 1971;  109 317-327
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 29 Messner K, Gillquist J. Cartilage repair. A critical review.  Acta Orthop Scand. 1996;  67 523-529
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Passler H H. Microfracture for treatment of cartilage defects.  Zentralbl Chir. 2000;  125 500-504
    PubMedGoogle Scholar
  • 33 Pridie K H. A method of resurfacing osteoarthritic knee joints.  J Bone Joint Surg [Br]. 1959;  41 618-619
    PubMedGoogle Scholar
  • 34 Rand J A, Ritts G D. Abrasion arthroplasty as a salvage for failed upper tibial osteotomy.  J Arthroplasty. 1989;  4 S45-48
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 36 Schneider U, Breusch S J, von der Mark K. Current status of autologous chondrocyte transplantation.  Z Orthop Ihre Grenzgeb. 1999;  137 386-392
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 40 Sledge S L. Microfracture techniques in the treatment of osteochondral injuries.  Clin Sports Med. 2001;  20 365-377
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar

Peter Angele

Abteilung für Unfallchirurgie
Universitätsklinik Regensburg

Franz-Josef-Strauß-Allee 11

93053 Regensburg

Phone: 0941/9446805

Fax: 0941/9446806

Email: peter.angele@klinik.uni-regensburg.de

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