Skip to main content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: rheuma plus 3/2015

01.09.2015 | Orthopädie

Orthopädisch-chirurgische Therapie des Gelenkknorpeldefektes

verfasst von: Prof. Dr. Stefan Nehrer

Erschienen in: rheuma plus | Ausgabe 3/2015

Einloggen, um Zugang zu erhalten
share
TEILEN

Zusammenfassung

Hintergrund

Die Tatsache, dass Gelenkknorpel nicht oder nur insuffizient heilt, ist altbekannt (Hunter, Philos Trans R Soc Lond 42b:514–521, 1743). Seit Jahrzehnten werden sehr aufwändige Versuche unternommen, die ungenügende Regenerationsfähigkeit von Knorpel zu verbessern. Operationsmethoden wie Bohrung und Abrasionsarthroplastik zur Behandlung von Knorpeldefekten können nur eine fibrokartilaginäre Vernarbung des Defektes erzielen, wobei der klinische Verlauf und die langfristige biomechanische Belastbarkeit dieses Narbengewebes unvorhersehbar bleiben.

Methoden

Osteochondrale Transplantationen mit Knochenzylindern sind technisch schwierig und mit limitierten Graftressourcen und Entnahmemorbidität behaftet. Allografts sind mit hohem logistischem Aufwand verbunden und bergen ein immunologisches und infektiöses Gefahrenpotenzial.

Ergebnisse

Die Implantation von kultivierten, autologen Chondrozyten bei akuten und chronischen Knorpeldefekten erzielte sowohl experimentell als auch in ersten klinischen Anwendungen eine verbesserte Regeneration von hyalinem Gelenkknorpel.

Schlussfolgerung

Die Einführung von Biomaterialien in der Knorpelzelltransplantation hat zur Entwicklung der Methoden des Tissue Engineering geführt, die sicher dazu beitragen, die Prognose bei der Behandlung von Knorpeldefekten noch weiter zu verbessern.
Literatur
1.
Zurück zum Zitat Bartlett W, Skinner JA, Gooding CR et al (2005) Autologous chondrocyte implantation versus matrixinduced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645 Bartlett W, Skinner JA, Gooding CR et al (2005) Autologous chondrocyte implantation versus matrixinduced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645
2.
Zurück zum Zitat Behrens P, Bitter T, Kurz B et al (2006) Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)-5-year follow-up. Knee 13:194–202 Behrens P, Bitter T, Kurz B et al (2006) Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)-5-year follow-up. Knee 13:194–202
3.
Zurück zum Zitat Bentley G, Green R (1971) Homotransplantation of isolated epiphyseal and articular cartilage chondrocytes into joint surfaces of rabbits. Nature 230:385–388 Bentley G, Green R (1971) Homotransplantation of isolated epiphyseal and articular cartilage chondrocytes into joint surfaces of rabbits. Nature 230:385–388
4.
Zurück zum Zitat Bentley G, Biant LC, Carrington RWJ et al (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85-B:223–230 Bentley G, Biant LC, Carrington RWJ et al (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85-B:223–230
5.
Zurück zum Zitat Bobic V (1996) Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Arthroscopy 3:262–264 Bobic V (1996) Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Arthroscopy 3:262–264
6.
Zurück zum Zitat Brittberg M et al (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–894 Brittberg M et al (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–894
7.
Zurück zum Zitat Buckwalter J et al (1988) Articular cartilage: composition and structure. In: Woo S-Y, Buckwalter J (eds) Injury and Repair of the Musculoskeletal Soft Tissues. AAOS, Park Ridge, Illinois Buckwalter J et al (1988) Articular cartilage: composition and structure. In: Woo S-Y, Buckwalter J (eds) Injury and Repair of the Musculoskeletal Soft Tissues. AAOS, Park Ridge, Illinois
8.
Zurück zum Zitat Curl WW, Krome J, Gordon ES et al (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460 Curl WW, Krome J, Gordon ES et al (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460
9.
Zurück zum Zitat Dorotka R, Windberger U, Macfelda K et al (2005) Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials 26:3617–3629 Dorotka R, Windberger U, Macfelda K et al (2005) Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials 26:3617–3629
10.
Zurück zum Zitat Engelhardt M, Mortier J, Megerle T et al (2001) Ergebnisse nach autologer Knorpelzelltransplantation am Kniegelenk. Arthritis und Rheuma 21:279–285 Engelhardt M, Mortier J, Megerle T et al (2001) Ergebnisse nach autologer Knorpelzelltransplantation am Kniegelenk. Arthritis und Rheuma 21:279–285
11.
Zurück zum Zitat Erggelet C, Sittinger M, Lahm A (2003) The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 19:108–110 Erggelet C, Sittinger M, Lahm A (2003) The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 19:108–110
12.
Zurück zum Zitat Gigante A, Bevilacqua C, Cappella M et al (2003) Engineered articular cartilage: influence of the scaffold on cell phenotype and proliferation. J Mater Sci Mater Med 14:713–716 Gigante A, Bevilacqua C, Cappella M et al (2003) Engineered articular cartilage: influence of the scaffold on cell phenotype and proliferation. J Mater Sci Mater Med 14:713–716
13.
Zurück zum Zitat Gigante A, Bevilacqua C, Ricevuto A et al (2007) Membrane-seeded autologous chondrocytes: cell viability and characterization at surgery. Knee Surg Sports Traumatol Arthrosc 15:88–92 Gigante A, Bevilacqua C, Ricevuto A et al (2007) Membrane-seeded autologous chondrocytes: cell viability and characterization at surgery. Knee Surg Sports Traumatol Arthrosc 15:88–92
14.
Zurück zum Zitat Gobbi A, Kon E, Berruto M et al (2006) Patellofemoral full-thickness chondral defects treated with Hyalograft- C: a clinical, arthroscopic, and histologic review. Am J Sports Med 34:1763–1773 Gobbi A, Kon E, Berruto M et al (2006) Patellofemoral full-thickness chondral defects treated with Hyalograft- C: a clinical, arthroscopic, and histologic review. Am J Sports Med 34:1763–1773
15.
Zurück zum Zitat Gooding CR, Bartlett W, Bentley G et al (2006) A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee 13:203–210 Gooding CR, Bartlett W, Bentley G et al (2006) A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee 13:203–210
16.
Zurück zum Zitat Grigolo B, Lisignoli G, Piacentini A et al (2002) Evidence for redifferentiation of human chondrocytes grown on a hyaluronan-based biomaterial (HYAff 11): molecular, immunohistochemical and ultrastructural analysis. Biomaterials 23:1187–1195 Grigolo B, Lisignoli G, Piacentini A et al (2002) Evidence for redifferentiation of human chondrocytes grown on a hyaluronan-based biomaterial (HYAff 11): molecular, immunohistochemical and ultrastructural analysis. Biomaterials 23:1187–1195
17.
Zurück zum Zitat Häuselmann HJ, Fernandes RJ, Mok SS et al (1994) Phenotypic stability of bovine articular chondrocytes after long-term culture in alginate beads. J Cell Sci 107:17–27 Häuselmann HJ, Fernandes RJ, Mok SS et al (1994) Phenotypic stability of bovine articular chondrocytes after long-term culture in alginate beads. J Cell Sci 107:17–27
18.
Zurück zum Zitat Hangody L et al (1996) Mosaicplasty for the treatment of articular cartilage defects: application in clincal practice. Orthopedics 21:751–756 Hangody L et al (1996) Mosaicplasty for the treatment of articular cartilage defects: application in clincal practice. Orthopedics 21:751–756
19.
Zurück zum Zitat Hendrickson DA, Nixon AJ, Grande DA et al (1994) Chondrocyte-fibrin matrix transplants for resurfacing extensive articular cartilage defects. J Orthop Res 12:485–496 Hendrickson DA, Nixon AJ, Grande DA et al (1994) Chondrocyte-fibrin matrix transplants for resurfacing extensive articular cartilage defects. J Orthop Res 12:485–496
20.
Zurück zum Zitat Homminga GN, Buma P, Koot HW et al (1993) Chondrocyte behaviour in fibrin glue in vitro. Acta Orthop Scand 64:441–445 Homminga GN, Buma P, Koot HW et al (1993) Chondrocyte behaviour in fibrin glue in vitro. Acta Orthop Scand 64:441–445
21.
Zurück zum Zitat Hunter W (1743) On the structure and disease of articulating cartilage. Philos Trans R Soc Lond 42b:514–521 Hunter W (1743) On the structure and disease of articulating cartilage. Philos Trans R Soc Lond 42b:514–521
22.
Zurück zum Zitat Iwasa J, Ochi M, Uchio Y et al (2003) Effects of cell density on proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel. Artif Organs 27:249–255 Iwasa J, Ochi M, Uchio Y et al (2003) Effects of cell density on proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel. Artif Organs 27:249–255
23.
Zurück zum Zitat Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87:2232–2239 Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87:2232–2239
24.
Zurück zum Zitat Kimura T, Yasui N, Ohsawa S et al (1984) Chondrocytes embedded in collagen gels maintain cartilage phenotype during long-term cultures. Clin Orthop Relat Res 186:231–239 Kimura T, Yasui N, Ohsawa S et al (1984) Chondrocytes embedded in collagen gels maintain cartilage phenotype during long-term cultures. Clin Orthop Relat Res 186:231–239
25.
Zurück zum Zitat Knutsen G, Engebretsen L, Ludvigsen TC et al (2004a). Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86:455–464 Knutsen G, Engebretsen L, Ludvigsen TC et al (2004a). Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86:455–464
26.
Zurück zum Zitat Mankin H, Fogelson F, Trasher A (1986) Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med 294:1247–1255 Mankin H, Fogelson F, Trasher A (1986) Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med 294:1247–1255
27.
Zurück zum Zitat Mankin H (1994) Chondrocyte transplantation an answer to an old question. N Eng J Med 331:940–941 Mankin H (1994) Chondrocyte transplantation an answer to an old question. N Eng J Med 331:940–941
28.
Zurück zum Zitat Marcacci M, Zaffagnini S, Kon E et al (2001) Arthroscopic autologous chondrocyte transplantation: technical note. Knee Surg Spons Traumatol Arthrosc 10:154–159 Marcacci M, Zaffagnini S, Kon E et al (2001) Arthroscopic autologous chondrocyte transplantation: technical note. Knee Surg Spons Traumatol Arthrosc 10:154–159
29.
Zurück zum Zitat Marcacci M, Kon E, Zaffagnini S et al (2007) Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 16:610–619 Marcacci M, Kon E, Zaffagnini S et al (2007) Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 16:610–619
30.
Zurück zum Zitat Marlovits S, Singer P, Zeller P et al (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 51:16–23 Marlovits S, Singer P, Zeller P et al (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 51:16–23
31.
Zurück zum Zitat Minas T, Nehrer S (1997) Current concepts in the treatment of articular cartilage defects. Orthopedics 20:525–538 Minas T, Nehrer S (1997) Current concepts in the treatment of articular cartilage defects. Orthopedics 20:525–538
32.
Zurück zum Zitat Mortier J, Engelhardt M (2000) Fremdkörperreaktion bei Karbonfaserstiftimplantation im Kniegelenk. Z Orthop 138:390–394 Mortier J, Engelhardt M (2000) Fremdkörperreaktion bei Karbonfaserstiftimplantation im Kniegelenk. Z Orthop 138:390–394
33.
Zurück zum Zitat Nehrer S. et al (1998) Chondrocyte-seeded collagen matrices implanted in a chondral defect in a canine model. Biomaterials 19:2313–2328 Nehrer S. et al (1998) Chondrocyte-seeded collagen matrices implanted in a chondral defect in a canine model. Biomaterials 19:2313–2328
34.
Zurück zum Zitat Nehrer S, Minas T (2000) Treatment of articular cartilage defects. Invest Radiol 35:639–646 Nehrer S, Minas T (2000) Treatment of articular cartilage defects. Invest Radiol 35:639–646
35.
Zurück zum Zitat Nehrer S, Chiari C, Domayer S et al (2008) Results of chondrocyte implantation with a fibrin-hyaluronan matrix: a preliminary study. Clin Orthop Relat Res 466:1849–1855 Nehrer S, Chiari C, Domayer S et al (2008) Results of chondrocyte implantation with a fibrin-hyaluronan matrix: a preliminary study. Clin Orthop Relat Res 466:1849–1855
36.
Zurück zum Zitat Nehrer S, Dorotka R, Domayer S et al (2009) Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years’ follow-up. Am J Sports Med 37(Suppl 1):81S–87S Nehrer S, Dorotka R, Domayer S et al (2009) Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years’ follow-up. Am J Sports Med 37(Suppl 1):81S–87S
37.
Zurück zum Zitat Ossendorf C, Kaps C, Kreuz PC et al (2007) Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based three-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther 9:R41 Ossendorf C, Kaps C, Kreuz PC et al (2007) Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based three-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther 9:R41
38.
Zurück zum Zitat Peterson L, Minas T (1999) Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 18:13–44 Peterson L, Minas T (1999) Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 18:13–44
39.
Zurück zum Zitat Schneider U, Rackwitz L, Andereya S et al (2011) A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaRes) for the repair of articular cartilage defects in the knee. Am J Sports Med 12:2558–2565 Schneider U, Rackwitz L, Andereya S et al (2011) A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaRes) for the repair of articular cartilage defects in the knee. Am J Sports Med 12:2558–2565
40.
Zurück zum Zitat Solchaga LA, Dennis JE, Goldberg VM et al (1999) Hyaluronic acid-based polymers as cell carriers for tissueengineered repair of bone and cartilage. J Orthop Res 17:205–213 Solchaga LA, Dennis JE, Goldberg VM et al (1999) Hyaluronic acid-based polymers as cell carriers for tissueengineered repair of bone and cartilage. J Orthop Res 17:205–213
41.
Zurück zum Zitat Steinwachs M, Kreuz PC (2007) Autologous chondrocyte implantation in chondral defects of the knee with a type I/III collagen membrane: a prospective study with a 3-year follow-up. Arthroscopy 23:381–387 Steinwachs M, Kreuz PC (2007) Autologous chondrocyte implantation in chondral defects of the knee with a type I/III collagen membrane: a prospective study with a 3-year follow-up. Arthroscopy 23:381–387
42.
Zurück zum Zitat Zheng MH, Willers C, Kirilak L et al (2007) Matrix-induced autologous chondrocyte implantation (MACI): biological and histological assessment. Tissue Eng 13:737–746 Zheng MH, Willers C, Kirilak L et al (2007) Matrix-induced autologous chondrocyte implantation (MACI): biological and histological assessment. Tissue Eng 13:737–746
Metadaten
Titel
Orthopädisch-chirurgische Therapie des Gelenkknorpeldefektes
verfasst von
Prof. Dr. Stefan Nehrer
Publikationsdatum
01.09.2015
Verlag
Springer Vienna
Erschienen in
rheuma plus / Ausgabe 3/2015
Print ISSN: 1868-260X
Elektronische ISSN: 2191-2610
DOI
https://doi.org/10.1007/s12688-015-0027-1

Weitere Artikel der Ausgabe 3/2015

rheuma plus 3/2015 Zur Ausgabe