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Erschienen in: rheuma plus 6/2021

29.07.2021 | Orthopädie

Stellenwert der chirurgischen Knorpeltherapie bei Früharthrose

verfasst von: Prof. Dr. Matthias J. Feucht, Kaywan Izadpanah, Stephan Vogt, Julian Mehl

Erschienen in: rheuma plus | Ausgabe 6/2021

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Zusammenfassung

Hintergrund

Im klinischen Alltag angewandte chirurgische Knorpeltherapieverfahren sind für fokale Knorpelschäden etabliert, allerdings sind in der Versorgungsrealität degenerative Knorpelschäden mit Affektion weiterer Kniebinnenstrukturen wesentlich häufiger. Dieses Stadium, in welchem klassische radiologische Arthrosezeichen fehlen, wird als Früharthrose bezeichnet und ist gekennzeichnet durch eine gestörte Gelenkhomöostase mit biomechanischen und biochemischen Veränderungen, welche sich negativ auf regenerative Knorpeltherapieverfahren auswirken können.

Indikation

Die Indikation zur chirurgischen Knorpeltherapie besteht bei der symptomatischen fokalen Früharthrose, welche nach Madry et al. definiert ist als Knorpeldegeneration ICRS(International Cartilage Repair Society)-Grad I oder II welche um einen fokalen Knorpelschaden ICRS-Grad III oder IV lokalisiert ist. Bei fortgeschrittener Arthrose mit deutlicher Gelenkspaltverschmälerung sind sämtliche chirurgischen Knorpeltherapieverfahren im Allgemeinen nur in Ausnahmefällen indiziert.

Therapie

Das am besten untersuchte Verfahren bei der Früharthrose ist die autologe Chondrozytentransplantation, welche in Fallserien akzeptable Ergebnisse erzielte, allerdings muss mit höheren Versagensraten als bei fokalen, traumatischen Knorpelschäden gerechnet werden. Der Nutzen von knochenmarkstimulierenden Techniken scheint bei der Früharthose limitiert zu sein und sollte lediglich bei kleinem Schaden < 2 cm2 sowie sehr gering ausgeprägter umgebender Knorpeldegeneration erfolgen. Einen sehr hohen Stellenwert nehmen Begleiteingriffe – insbesondere Umstellungsosteotomien – ein.
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Metadaten
Titel
Stellenwert der chirurgischen Knorpeltherapie bei Früharthrose
verfasst von
Prof. Dr. Matthias J. Feucht
Kaywan Izadpanah
Stephan Vogt
Julian Mehl
Publikationsdatum
29.07.2021
Verlag
Springer Vienna
Erschienen in
rheuma plus / Ausgabe 6/2021
Print ISSN: 1868-260X
Elektronische ISSN: 2191-2610
DOI
https://doi.org/10.1007/s12688-021-00468-1