Einzeitige Rekonstruktion osteochondraler Defekte am Kniegelenk bei Osteochondrosis dissecans

Cartilage repair techniques have been among the most intensively investigated treatments in orthopedics for the past decade, and several different treatment modalities are currently available. Despite the extensive research effort within this field, the generation of hyaline cartilage remains a considerable challenge. There are many parameters attendant to each of the cartilage repair techniques that can affect the amount and types of reparative tissue generated in the cartilage defect, and some of the most fundamental of these parameters have yet to be fully investigated. For procedures in which in vitro–cultured autologous chondrocytes are implanted under a periosteal or synthetic membrane cover, or seeded onto a porous membrane or scaffold, little is known about how the number of cells affects the clinical outcome. Few published clinical studies address the cell seeding density that was employed. The principal objective of this review is to provide an overview of the cell seeding densities used in cell-based treatments currently available in the clinic for cartilage repair. Select preclinical studies that have informed the use of specific cell seeding densities in the clinic are also discussed.

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“…The average follow-up was 16 months, and patients showed significant improvement compared to baseline. 41 …”

Section: Clinical Treatmentsmentioning

confidence: 99%

Cell Seeding Densities in Autologous Chondrocyte Implantation Techniques for Cartilage Repair

et al. 2012

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“…After a mean follow-up of 16 months, they found significantly improved IKDC- and Lysholm-scores compared to the preoperative status. 31 They did not perform MR imaging in the follow-up. In addition, it did not become clear how they could perform chondrocyte transplantation in a one-step-procedure.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of osteochondral defects by combined bone grafting and a bilayer collagen membrane as a sandwich technique

Petri¹,

Ettinger

Falck

et al. 2013

Orthop Rev

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Treatment of osteochondral lesions of the knee remains a major challenge in orthopedic surgery. Recently established procedures like autologous chondrocyte implantation or matrix-associated chondrocyte implantation yield good results, but include the disadvantage of two-step procedures. The purpose of this study was to evaluate the clinical and magnetic resonance imaging outcome of repairs of osteochondral defects of the knee by a combined procedure of bone grafting and covering with a bilayer collagen membrane in a sandwich technique. Seven male patients with a mean age of 42 (range 30-55) years and symptomatic focal osteochondral lesions of the knee grade IV according to the International Cartilage Repair Society classification were included. The mean diameter of defects was 28.6 (range 15-40) mm. Results were evaluated at a minimum of 24 months after surgery by International Knee Documentation Committee score, Lysholm-score, visual analogue scale, and magnetic resonance imaging with specific cartilage sequences, evaluating the ICRS score and the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. All patients judged the operation as successful. Among the patients available for the long-term follow-up, mean visual analogue scale value was 1.3 (range 0-3) out of 10 points. Mean International Knee Documentation Committee score was 80.8 (range 63.2-88.5) out of 100 points. Mean Lysholm score was 85 (range 55-95) out of 100 points. None of the patients had to be reoperated until today. Evaluation of magnetic resonance imaging using the MOCART score revealed a good correlation to the clinical outcome. This is the first study reporting results after reconstruction of osteochondral defects of the knee joint by bone grafting and a bilayer collagen membrane. This new method offers the advantage of a one-step-procedure and yields both good clinical and magnetic resonance findings. We conclude that this procedure can be a valuable tool to improve joint function after osteochondral defects, trauma, and in joints with local arthritic lesions.

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“…Sie konnten mittels IKDC-Fragebogen eine subjektive Beurteilung von durchschnittlich 69 Punkten nachweisen. Dieses Ergebnis entspricht den Ergebnissen vorheriger Untersuchungen zu chondralen Defekten und zeigt, dass matrixgekoppelte Verfahren eine Alternative zu den bisherigen Verfahren darstellen können [13]. Die von uns verwendete Trägermatrix (CaReS ® ) ist in Bezug auf ihre Kultivierungseigenschaften untersucht und befindet sich im klinischen Einsatz [9,11,12].…”

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“…Eine detaillierte Beschreibung der klinischen Ergebnisse der behandelten osteochondralen Defekte (n = 14) ist dieser Untersuchung jedoch nicht zu entnehmen. Ochs et al[13] konnten anhand der Verläufe von 22 Patienten über 16 (6 -36) Monate gute klinische Ergebnisse für die Verwendung kortikospongiöser Zylinder und matrixassoziierter autologer Chondrozytentransplantation (Novocart ® 3D) zeigen. Die in der vorliegenden Studie verwendete kollagengelgekoppelte autologe Chondrozytentransplantation (CaReS ® ) befindet sich bereits im klinischen Einsatz.…”

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“…Der größte von uns behandelte Defekt betrug 13,5 cm 2 , die durchschnittliche Defektgröße lag bei 8,1 cm 2 . Im Vergleich zu der Untersuchung von Ochs et al[13] waren die Defekte in der vorliegenden Untersuchung deutlich größer, wobei ein direkter Vergleich der Ergebnisse beider Studien aufgrund unterschiedlicher Scoresysteme schwierig ist. Die Betrachtung des in beiden Studien verwendeten subjektiven IKDC-2000-Fragebogens zeigt jedoch ein vergleichbares Ergebnis von 66,1 (± 17,0) nach 36 Monaten in unserer Studie zu 69,1 (± 19,1) nach durchschnittlich 16 Monaten in der von Ochs et al publizierten Untersuchung.…”

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Klinische Drei-Jahres-Ergebnisse der matrixgekoppelten ACT zur Behandlung osteochondraler Defekte am Kniegelenk

Maus¹,

Schneider²,

Gravius³

et al. 2008

Z Orthop Unfall

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Einzeitige Rekonstruktion osteochondraler Defekte am Kniegelenk bei Osteochondrosis dissecans

Abstract: The simultaneous reconstruction of deep osteochondral detects of the knee joint with bone grafting and matrix-supported autologous chondrocyte transplantation in osteochondritis dissecans is a biological, one-step alternative to previously reported methods with encouraging first results.

Cited by 36 publications

References 18 publications

Cell Seeding Densities in Autologous Chondrocyte Implantation Techniques for Cartilage Repair

Cell Seeding Densities in Autologous Chondrocyte Implantation Techniques for Cartilage Repair

Reconstruction of osteochondral defects by combined bone grafting and a bilayer collagen membrane as a sandwich technique

Klinische Drei-Jahres-Ergebnisse der matrixgekoppelten ACT zur Behandlung osteochondraler Defekte am Kniegelenk

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