Chirurgische Therapieverfahren zur Behandlung umschriebener Knorpelschäden am Kniegelenk

Zusammenfassung

Knorpelschäden stellen vor dem Hintergrund der aktuellen demografischen Entwicklung und den zunehmenden Ansprüchen von Patienten mittleren Alters bezüglich Aktivität und Sportfähigkeit ein quantitativ zunehmendes Problem dar. Zur Behandlung isolierter Knorpeldefekte steht mittlerweile eine Vielzahl von chirurgischen Verfahren zur Verfügung, welche zum Teil ähnlichen biologischen Prinzipien Folge leisten, sich aber auch erheblich bezüglich der Invasivität, des Kostenfaktors und der Behandlungsergebnisse unterscheiden. Eine Therapie dieser Defekte soll nicht nur zur aktuellen Beschwerdelinderung des Patienten beitragen. Die Therapie isolierter Knorpeldefekte stellt auch eine Prävention bezüglich des Auftretens einer sekundären Arthrose dar. Insbesondere in den vergangenen Jahren wurden neue Verfahren etabliert, die auf ihre Wertigkeit überprüft werden müssen. Es bleibt somit dem Chirurgen überlassen, die für den individuellen Patienten ideale Therapie anzuwenden. Der vorliegende Artikel gibt einen Überblick über die aktuell zur Verfügung stehenden Verfahren zur Behandlung isolierter Knorpeldefekte, versucht, die Verfahren zu bewerten und Entscheidungshilfen zu geben, bei welchen Indikationen die unterschiedlichen Verfahren für den Patienten von Vorteil sind. Dies ist vor allem deshalb von Bedeutung, weil nur unter Beachtung der entsprechenden Indikation für den individuellen Patienten das bestmögliche Therapieergebnis erreicht werden kann.

Abstract

With regard to the current demographic changes in today’s population and the increasing demands of the patients i. e. in sports activity, the operative treatment of chondral lesions gained of importance in recent years. The treatment of cartilage injuries is not only of great importance in order to reduce the patients‘ symptoms, but also intends to avoid the appaerance of secondary arthrosis. There are several different techniques available for the treatment of full-thickness defects (such as microfracturing and autologous chondrocyte implantation), some of them following related principles. The choice of the optimal treatment technique remains of great importance and represents one of the major responsibilities of the surgeon in order to achieve optimal results. The current article respresents a review of current techniques and developments in operative cartilage repair of the knee joint and gives help in the decision-making process, since the use of the appropriate technique becomes more and more important in order to achieve optimal clinical results.

Schlüsselwörter

Knorpelschaden - Mikrofrakturierung - autologe Chondrozytentransplantation - mesenchymale Stammzelle - operative Knorpeltherapie - Kniegelenk

Key words

cartilage lesion - microfracturing - autologous chondrocyte implantation - mesenchymal stem cell - cartilage repair - knee joint

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