Operative Knorpeltherapie aktuell

Zusammenfassung

Fokale Knorpelschäden gehen mit Schwellung, Funktionsverlust der betroffenen Gelenke und starker Schmerzsymptomatik einher. Zudem werden sie mit der Entstehung einer späteren Arthrose in Verbindung gebracht. Oftmals betroffen sind hierbei junge, sportlich aktive Patienten, die einen hohen funktionellen Anspruch haben. Die Behandlungsmöglichkeiten des Orthopäden in Bezug auf knorpelregenerative Therapiemöglichkeiten an Knie, Hüfte, Schulter, Ellenbogen und Sprunggelenk sind mannigfaltig.

Abstract

Focal cartilage defects lead to swelling, significant pain and loss of function of the affected joint. Additionally, they are linked to early onset of osteoarthritis. Often young and active patients are especially susceptible due to the high stress placed on their joints. A vast amount of treatment options is available to orthopaedic surgeons to cure cartilage defects of the knee, hip, shoulder, elbow and ankle joints. This article serves to give an overview of these available treatment options and to explain the expected outcomes.

Lernziele

Nach der Lektüre dieses Beitrages können Sie …

• festlegen, welche Knorpelschäden operativ behandelt werden sollten,

• bestimmen, welche Knorpelschäden welcher Therapie zugeführt werden sollten,

• Unterschiede in Bezug auf die Knorpeltherapie an den verschiedenen Gelenken berücksichtigen,

• das richtige Therapieverfahren für Ihren Patienten wählen,

• die Relevanz von Begleitpathologien einschätzen und

• Ihre Patienten eingehend in Bezug auf das zu erwartende funktionelle Ergebnis beraten.

Kernaussagen

1. Fokale Knorpelschäden können zu Schwellungen, erheblichen Schmerzen und einem Funktionsverlust des betroffenen Gelenkes fühlen. Bleiben fokale, symptomatische Knorpelschäden unbehandelt, kann die Progression zu einer Arthrose beschleunigt und die Lebensqualität deutlich gemindert werden.

2. Fokale Knorpelschäden sind von einer Arthrose abzugrenzen. Die Arthrose betrifft – anders als der fokale Knorpelschaden – außerdem weitere Strukturen wie die Synovia und Bänder und ist durch eine katabole, inflammatorische Stoffwechsellage gekennzeichnet.

3. Mittel der Wahl zur Beurteilung eines Knorpeldefekts ist die MRT-Untersuchung des betroffenen Gelenkes. Ist außerdem der subchondrale Knochen betroffen, sollte zusätzlich eine CT-Untersuchung erfolgen.

4. Dem Orthopäden steht eine Vielzahl an Therapieoptionen zur Verfügung, um Knorpeldefekte im Knie-, Hüft-, Schulter-, Ellenbogen- und Sprunggelenk zu behandeln. Vor Beginn einer Knorpeltherapie sollten jedoch – unabhängig vom zu behandelnden Gelenk – Begleitpathologien ausgeschlossen oder mitbehandelt werden.

5. Die Mikrofrakturierung stellt weiterhin eine gute Möglichkeit dar, um kleine chondrale Läsionen zu behandeln.

6. Bei größeren Läsionen ist meist eine autologe Chondrozytentransplantation (ACT) indiziert, welche zweizeitig erfolgt. Im ersten Eingriff werden Knorpelzellen aus einem unbelasteten Gelenkbereich entnommen, dann angezüchtet, und in einem zweiten Eingriff in den Defekt reimplantiert.

7. Bei osteochondralen Läsionen sollte der geschädigte subchondrale Knochen mitbehandelt werden. Für kleine Läsionen stellt die osteochondrale Autograft-Transplantation (OAT), bei der ein Knorpel-Knochen-Zylinder – meist aus einer unbelasteten Zone des Kniegelenks – entnommen und in das Defektbett implantiert wird, eine gute Therapieoption dar.

Schlüsselwörter

Knorpelschaden - Arthrose - Knie - Schulter - Ellenbogen - Sprunggelenk - Knorpel

Key words

cartilage defect - osteoarthritis - knee - shoulder - elbow - ankle - cartilage

Publication History

Article published online:
11 May 2021

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