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Sportverletz Sportschaden 2007; 21(1): 41-50
DOI: 10.1055/s-2007-963030
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Chirurgische Therapieverfahren zur Behandlung umschriebener Knorpelschäden am Kniegelenk

Operative Treatment of Cartilage Lesions in the Knee JointP. Niemeyer1 , P. C. Kreuz1 , M. Steinwachs1 , N. P. Südkamp1
  • 1Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg
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Publication History

Publication Date:
23 March 2007 (online)

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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

Literatur

  • 1 Curl W W, Krome J, Gordon E S. et al . Cartilage injuries: a review of 31 516 knee arthroscopies.  Arthroscopy. 1997;  13 (4) 456-460
    CrossrefPubMedGoogle Scholar
  • 2 Hjelle K, Solheim E, Strand T. et al . Articular cartilage defects in 1000 knee arthroscopies.  Arthroscopy. 2002;  18 (7) 730-734
    CrossrefPubMedGoogle Scholar
  • 3 Messner K, Maletius W. The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes.  Acta Orthop Scand. 1996;  67 (2) 165-168
    PubMedGoogle Scholar
  • 4 Buckwalter J A. Articular cartilage: injuries and potential for healing.  J Orthop Sports Phys Ther. 1998;  28 (4) 192-202
    CrossrefPubMedGoogle Scholar
  • 5 Brittberg M, Winalski C S. Evaluation of cartilage injuries and repair.  J Bone Joint Surg Am. 2003;  85 (A Suppl 2) 58-69
    PubMedGoogle Scholar
  • 6 Mankin H J. The response of articular cartilage to mechanical injury.  J Bone Joint Surg Am. 1982;  64 (3) 460-466
    PubMedGoogle Scholar
  • 7 Mitchell N, Shepard N. The resurfacing of adult rabbit articular cartilage by multiple perforations through the subchondral bone.  J Bone Joint Surg Am. 1976;  58 (2) 230-233
    PubMedGoogle Scholar
  • 8 Shapiro F, Koide S, Glimcher M J. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage.  J Bone Joint Surg Am. 1993;  75 (4) 532-553
    PubMedGoogle Scholar
  • 9 Furukawa T, Eyre D R, Koide S. et al . Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee.  J Bone Joint Surg Am. 1980;  62 (1) 79-89
    PubMedGoogle Scholar
  • 10 Kreuz P C, Steinwachs M R, Erggelet C. et al . Results after microfracture of full-thickness chondral defects in different compartments in the knee.  Osteoarthritis Cartilage. 2006;  14 (11) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 11 Jackson R W, Dieterichs C. The results of arthroscopic lavage and debridement of osteoarthritic knees based on the severity of degeneration: a 4- to 6-year symptomatic follow-up.  Arthroscopy. 2003;  19 (1) 13-20
    PubMedGoogle Scholar
  • 12 Jackson R W, Gilbert J E, Sharkey P F. Arthroscopic debridement versus arthroplasty in the osteoarthritic knee.  J Arthroplasty. 1997;  12 (4) 465- - 469; discussion 469 - 470
    PubMedGoogle Scholar
  • 13 Hubbard M J. Articular debridement versus washout for degeneration of the medial femoral condyle. A five-year study.  J Bone Joint Surg Br. 1996;  78 (2) 217-219
    PubMedGoogle Scholar
  • 14 Moseley J B, O’Malley K, Petersen N J. et al . A controlled trial of arthroscopic surgery for osteoarthritis of the knee.  N Engl J Med. 2002;  347 (2) 81-88
    Google Scholar
  • 15 Insall J. The Pridie debridement operation for osteoarthritis of the knee.  Clin Orthop Relat Res. 1974;  101 61-67
    PubMedGoogle Scholar
  • 16 Beiser I H, Kanat I O. Subchondral bone drilling: a treatment for cartilage defects.  J Foot Surg. 1990;  29 (6) 595-601
    PubMedGoogle Scholar
  • 17 Hunt S A, Jazrawi L M, Sherman O H. Arthroscopic management of osteoarthritis of the knee.  J Am Acad Orthop Surg. 2002;  10 (5) 356-363
    PubMedGoogle Scholar
  • 18 Dandy D J. Abrasion chondroplasty.  Arthroscopy. 1986;  2 (1) 51-53
    PubMedGoogle Scholar
  • 19 Johnson L L. Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status.  Arthroscopy. 1986;  2 (1) 54-69
    CrossrefPubMedGoogle Scholar
  • 20 Johnson L L. Arthroscopic abrasion arthroplasty: a review.  Clin Orthop Relat Res. 2001;  391 (Suppl) S306-317
    CrossrefPubMedGoogle Scholar
  • 21 Kim H K, Moran M E, Salter R B. The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits.  J Bone Joint Surg Am. 1991;  73 (9) 1301-1315
    PubMedGoogle Scholar
  • 22 Akizuki S, Yasukawa Y, Takizawa T. Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone.  Arthroscopy. 1997;  13 (1) 9-17
    CrossrefPubMedGoogle Scholar
  • 23 Menche D S, Frenkel S R, Blair B. et al . A comparison of abrasion burr arthroplasty and subchondral drilling in the treatment of full-thickness cartilage lesions in the rabbit.  Arthroscopy. 1996;  12 (3) 280-286
    PubMedGoogle Scholar
  • 24 Steadman J R, Rodkey W G, Briggs K K. et al . The microfracture technic in the management of complete cartilage defects in the knee joint.  Orthopade. 1999;  28 (1) 26-32
    CrossrefPubMedGoogle Scholar
  • 25 Steadman J R, Rodkey W G, Rodrigo J J. Microfracture: surgical technique and rehabilitation to treat chondral defects.  Clin Orthop Relat Res. 2001;  391 (Suppl) S362-369
    CrossrefPubMedGoogle Scholar
  • 26 Bae D K, Yoon K H, Song S J. Cartilage healing after microfracture in osteoarthritic knees.  Arthroscopy. 2006;  22 (4) 367-374
    PubMedGoogle Scholar
  • 27 Mithoefer K, Williams R J 3rd, Warren R F. et al . The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study.  J Bone Joint Surg Am. 2005;  87 (9) 1911-1920
    CrossrefPubMedGoogle Scholar
  • 28 Steadman J R, Rodkey W G, Briggs K K. Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes.  J Knee Surg. 2002;  15 (3) 170-176
    PubMedGoogle Scholar
  • 29 Steadman J R, Briggs K K, Rodrigo J J. et al . Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up.  Arthroscopy. 2003;  19 (5) 477-484
    CrossrefPubMedGoogle Scholar
  • 30 Frisbie D D, Oxford J T, Southwood L. et al . Early events in cartilage repair after subchondral bone microfracture.  Clin Orthop Relat Res. 2003;  407 215-227
    PubMedGoogle Scholar
  • 31 Steinwachs M R, Kreuz P C, Krause S J. et al . Klinische Ergebnisse nach Mikrofrakturierung bei der Behandlung von Gelenkknorpeldefekten.  Sportorthopädie - Sporttraumatologie. 2003;  19 291-294
    PubMedGoogle Scholar
  • 32 Kramer J, Bohrnsen F, Lindner U. et al . In vivo matrix-guided human mesenchymal stem cells.  Cell Mol Life Sci. 2006;  63 (5) 616-626
    CrossrefPubMedGoogle Scholar
  • 33 Hui J H, Li L, Teo Y H. et al . Comparative study of the ability of mesenchymal stem cells derived from bone marrow, periosteum, and adipose tissue in treatment of partial growth arrest in rabbit.  Tissue Eng. 2005;  11 (5 - 6) 904-912
    CrossrefPubMedGoogle Scholar
  • 34 Arnold U, Lindenhayn K, Perka C. In vitro-cultivation of human periosteum derived cells in bioresorbable polymer-TCP-composites.  Biomaterials. 2002;  23 (11) 2303-2310
    CrossrefPubMedGoogle Scholar
  • 35 Carranza-Bencano A, Garcia-Paino L, Armas Padron J R. et al . Neochondrogenesis in repair of full-thickness articular cartilage defects using free autogenous periosteal grafts in the rabbit. A follow-up in six months.  Osteoarthritis Cartilage. 2000;  8 (5) 351-358
    CrossrefPubMedGoogle Scholar
  • 36 Carranza-Bencano A, Perez-Tinao M, Ballesteros-Vazquez P. et al . Comparative study of the reconstruction of articular cartilage defects with free costal perichondrial grafts and free tibial periosteal grafts: an experimental study on rabbits.  Calcif Tissue Int. 1999;  65 (5) 402-407
    CrossrefPubMedGoogle Scholar
  • 37 Bouwmeester P S, Kuijer R, Homminga G N. et al . A retrospective analysis of two independent prospective cartilage repair studies: autogenous perichondrial grafting versus subchondral drilling 10 years post-surgery.  J Orthop Res. 2002;  20 (2) 267-273
    CrossrefPubMedGoogle Scholar
  • 38 Angermann P, Riegels-Nielsen P, Pedersen H. Osteochondritis dissecans of the femoral condyle treated with periosteal transplantation. Poor outcome in 14 patients followed for 6 - 9 years.  Acta Orthop Scand. 1998;  69 (6) 595-597
    PubMedGoogle Scholar
  • 39 Bruns J, Steinhagen J. Treatment of deep hyalin cartilage defects with autologous perichondrial grafts.  Int J Sports Med. 2003;  24 (5) 382-388
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Hangody L, Feczko P, Bartha L. et al . Mosaicplasty for the treatment of articular defects of the knee and ankle.  Clin Orthop Relat Res. 2001;  391 (Suppl) S328-336
    CrossrefPubMedGoogle Scholar
  • 41 Hangody L, Kish G, Karpati Z. et al . Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report.  Knee Surg Sports Traumatol Arthrosc. 1997;  5 (4) 262-267
    CrossrefPubMedGoogle Scholar
  • 42 Garrett J C. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults.  Clin Orthop Relat Res. 1994;  303 33-37
    PubMedGoogle Scholar
  • 43 Garrett J C. Treatment of osteochondral defects of the distal femur with fresh osteochondral allografts: a preliminary report.  Arthroscopy. 1986;  2 (4) 222-226
    PubMedGoogle Scholar
  • 44 Matsusue Y, Yamamuro T, Hama H. Arthroscopic multiple osteochondral transplantation to the chondral defect in the knee associated with anterior cruciate ligament disruption.  Arthroscopy. 1993;  9 (3) 318-321
    CrossrefPubMedGoogle Scholar
  • 45 Chow J C, Hantes M E, Houle J B. et al . Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study.  Arthroscopy. 2004;  20 (7) 681-690
    PubMedGoogle Scholar
  • 46 Bobic V. Autologous osteo-chondral grafts in the management of articular cartilage lesions.  Orthopade. 1999;  28 (1) 19-25
    PubMedGoogle Scholar
  • 47 Bobic V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study.  Knee Surg Sports Traumatol Arthrosc. 1996;  3 (4) 262-264
    CrossrefPubMedGoogle Scholar
  • 48 Bentley G, Biant L C, Carrington R W. et al . A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee.  J Bone Joint Surg Br. 2003;  85 (2) 223-230
    CrossrefPubMedGoogle Scholar
  • 49 Gudas R, Stankevicius E, Monastyreckiene E. et al . Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 (9) 834-842
    CrossrefPubMedGoogle Scholar
  • 50 Hunziker E B. Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects.  Osteoarthritis Cartilage. 2002;  10 (6) 432-463
    CrossrefPubMedGoogle Scholar
  • 51 Evans P J, Miniaci A, Hurtig M B. Manual punch versus power harvesting of osteochondral grafts.  Arthroscopy. 2004;  20 (3) 306-310
    PubMedGoogle Scholar
  • 52 LaPrade R F, Botker J C. Donor-site morbidity after osteochondral autograft transfer procedures.  Arthroscopy. 2004;  20 (7) e69-e73
    PubMedGoogle Scholar
  • 53 Brittberg M, Lindahl A, Nilsson A. et al . Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.  N Engl J Med. 1994;  331 (14) 889-895
    CrossrefPubMedGoogle Scholar
  • 54 Steinwachs M R, Erggelet C, Lahm A. et al . Clinical and cell biology aspects of autologous chondrocytes transplantation.  Unfallchirurg. 1999;  102 (11) 855-860
    CrossrefPubMedGoogle Scholar
  • 55 Grande D A, Pitman M I, Peterson L. et al . The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation.  J Orthop Res. 1989;  7 (2) 208-218
    CrossrefPubMedGoogle Scholar
  • 56 Breinan H A, Minas T, Hsu H P. et al . Autologous chondrocyte implantation in a canine model: change in composition of reparative tissue with time.  J Orthop Res. 2001;  19 (3) 482-492
    PubMedGoogle Scholar
  • 57 Breinan H A, Minas T, Hsu H P. et al . Effect of cultured autologous chondrocytes on repair of chondral defects in a canine model.  J Bone Joint Surg Am. 1997;  79 (10) 1439-1451
    PubMedGoogle Scholar
  • 58 Breinan H A, Martin S D, Hsu H P. et al . Healing of canine articular cartilage defects treated with microfracture, a type-II collagen matrix, or cultured autologous chondrocytes.  J Orthop Res. 2000;  18 (5) 781-789
    CrossrefPubMedGoogle Scholar
  • 59 Peterson L, Minas T, Brittberg M. et al . Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years.  J Bone Joint Surg Am. 2003;  85 (A Suppl 2) 17-24
    CrossrefPubMedGoogle Scholar
  • 60 Peterson L, Brittberg M, Kiviranta I. et al . Autologous chondrocyte transplantation. Biomechanics and long-term durability.  Am J Sports Med. 2002;  30 (1) 2-12
    PubMedGoogle Scholar
  • 61 Drobnic M, Kregar-Velikonja N, Radosavljevic D. et al . The outcome of autologous chondrocyte transplantation treatment of cartilage lesions in the knee.  Cell Mol Biol Lett. 2002;  7 (2) 361-363
    PubMedGoogle Scholar
  • 62 Erggelet C, Steinwachs M R, Reichelt A. The operative treatment of full thickness cartilage defects in the knee joint with autologous chondrocyte transplantation.  Saudi Med J. 2000;  21 (8) 715-721
    PubMedGoogle Scholar
  • 63 Knutsen G, Engebretsen L, Ludvigsen T C. et al . Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial.  J Bone Joint Surg Am. 2004;  86 (A 3) 455-464
    PubMedGoogle Scholar
  • 64 Peterson L, Minas T, Brittberg M. et al . Two- to 9-year outcome after autologous chondrocyte transplantation of the knee.  Clin Orthop Relat Res. 2000;  374 212-234
    CrossrefPubMedGoogle Scholar
  • 65 Henderson I, Francisco R, Oakes B. et al . Autologous chondrocyte implantation for treatment of focal chondral defects of the knee - a clinical, arthroscopic, MRI and histologic evaluation at 2 years.  Knee. 2005;  12 (3) 209-216
    CrossrefPubMedGoogle Scholar
  • 66 Henderson I, Tuy B, Oakes B. Reoperation after autologous chondrocyte implantation. Indications and findings.  J Bone Joint Surg Br. 2004;  86 (2) 205-211
    CrossrefPubMedGoogle Scholar
  • 67 Steinwachs M R, Kreuz P C. Clinical Results of Autologous Chondrocyte Transplantation (ACT) Using a Collagen Membrane Cartilage Surgery and Future Perspectives. Hendrich N, Eulert J Cartilage Surgery and Future Perspectives. Chapter 5 2003: 37-47
    Google Scholar
  • 68 Haddo O, Mahroof S, Higgs D. et al . The use of chondrogide membrane in autologous chondrocyte implantation.  Knee. 2004;  11 (1) 51-55
    CrossrefPubMedGoogle Scholar
  • 69 Marlovits S, Zeller P, Singer P. et al . Cartilage repair: generations of autologous chondrocyte transplantation.  Eur J Radiol. 2006;  57 (1) 24-31
    CrossrefPubMedGoogle Scholar
  • 70 Erggelet C, Sittinger M, Lahm A. The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint.  Arthroscopy. 2003;  19 (1) 108-110
    PubMedGoogle Scholar
  • 71 Pavesio A, Abatangelo G, Borrione A. et al . Hyaluronan-based scaffolds (Hyalograft C) in the treatment of knee cartilage defects: preliminary clinical findings.  Novartis Found Symp. 2003;  249 203-217; discussion 229 - 233, 234 - 238, 239 - 241
    PubMedGoogle Scholar
  • 72 Behrens P, Bitter T, Kurz B. et al . Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI) - 5-year follow-up.  Knee. 2006;  13 (3) 194-202
    CrossrefPubMedGoogle Scholar
  • 73 Perka C, Schultz O, Sittinger M. et al . Chondrocyte transplantation in PGLA/polydioxanone fleece.  Orthopade. 2000;  29 (2) 112-119
    PubMedGoogle Scholar
  • 74 Sittinger M, Bujia J, Minuth W W. et al . Engineering of cartilage tissue using bioresorbable polymer carriers in perfusion culture.  Biomaterials. 1994;  15 (6) 451-456
    PubMedGoogle Scholar
  • 75 Andereya S, Maus U, Gavenis K. et al . First clinical experiences with a novel 3D-collagen gel (CaReS) for the treatment of focal cartilage defects in the knee.  Z Orthop Ihre Grenzgeb. 2006;  144 (3) 272-280
    Article in Thieme ConnectPubMedGoogle Scholar
  • 76 Schneider U, Andereya S. First results of a prospective randomized clinical trial on traditional chondrocyte transplantation vs CaReS-Technology.  Z Orthop Ihre Grenzgeb. 2003;  141 (5) 496-497
    PubMedGoogle Scholar
  • 77 Nehrer S, Domayer S, Dorotka R. et al . Three-year clinical outcome after chondrocyte transplantation using a hyaluronan matrix for cartilage repair.  Eur J Radiol. 2006;  57 (1) 3-8
    CrossrefPubMedGoogle Scholar
  • 78 Gavenis K, Schmidt-Rohlfing B, Mueller-Rath R. et al . In vitro comparison of six different matrix systems for the cultivation of human chondrocytes.  In Vitro Cell Dev Biol Anim. 2006;  42 (5 - 6) 159-167
    CrossrefPubMedGoogle Scholar
  • 79 Russlies M, Ruther P, Koller W. et al . Biomechanical properties of cartilage repair tissue after different cartilage repair procedures in sheep.  Z Orthop Ihre Grenzgeb. 2003;  141 (4) 465-471
    Article in Thieme ConnectPubMedGoogle Scholar
  • 80 Bartlett W, Skinner J A, Gooding C R. et al . Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study.  J Bone Joint Surg Br. 2005;  87 (5) 640-645
    PubMedGoogle Scholar
  • 81 Minas T. Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life.  Am J Orthop. 1998;  27 (11) 739-744
    PubMedGoogle Scholar
  • 82 Lindahl A, Brittberg M, Peterson L. Health economics benefits following autologous chondrocyte transplantation for patients with focal chondral lesions of the knee.  Knee Surg Sports Traumatol Arthrosc. 2001;  9 (6) 358-363
    CrossrefPubMedGoogle Scholar
  • 83 Lindahl A, Brittberg M, Peterson L. Cartilage repair with chondrocytes: clinical and cellular aspects.  Novartis Found Symp. 2003;  249 175-186; discussion 186 - 189, 234 - 238, 239 - 241
    PubMedGoogle Scholar
  • 84 Clar C, Cummins E, McIntyre L. et al . Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation.  Health Technol Assess. 2005;  9 (47) iii-iv, ix-x, 1 - 82
    PubMedGoogle Scholar
  • 85 Kawahara Y, Uetani M, Nakahara N. et al . Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee. Correlation of MR and arthroscopic findings.  Acta Radiol. 1998;  39 (2) 120-125
    PubMedGoogle Scholar
  • 86 Pittenger M F, Mackay A M, Beck S C. et al . Multilineage potential of adult human mesenchymal stem cells.  Science. 1999;  284 (5411) 143-147
    CrossrefPubMedGoogle Scholar
  • 87 Mackay A M, Beck S C, Murphy J M. et al . Chondrogenic differentiation of cultured human mesenchymal stem cells from marrow.  Tissue Eng. 1998;  4 (4) 415-428
    CrossrefPubMedGoogle Scholar
  • 88 Caplan A I, Elyaderani M, Mochizuki Y. et al . Principles of cartilage repair and regeneration.  Clin Orthop Relat Res. 1997;  342 254-269
    PubMedGoogle Scholar
  • 89 Niemeyer P, Mehlhorn A, Jaeger M. et al . Adult mesenchymal stem cells for the regeneration of musculoskeletal tissue.  MMW Fortschr Med. 2004;  146 (Suppl 3 - 4) 107-113
    PubMedGoogle Scholar
  • 90 Wakitani S, Goto T, Pineda S J. et al . Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage.  J Bone Joint Surg Am. 1994;  76 (4) 579-592
    PubMedGoogle Scholar
  • 91 Wakitani S, Yamamoto T. Response of the donor and recipient cells in mesenchymal cell transplantation to cartilage defect.  Microsc Res Tech. 2002;  58 (1) 14-18
    CrossrefPubMedGoogle Scholar
  • 92 Wakitani S, Imoto K, Yamamoto T. et al . Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees.  Osteoarthritis Cartilage. 2002;  10 (3) 199-206
    CrossrefPubMedGoogle Scholar
  • 93 Wakitani S, Mitsuoka T, Nakamura N. et al . Autologous bone marrow stromal cell transplantation for repair of full-thickness articular cartilage defects in human patellae: two case reports.  Cell Transplant. 2004;  13 (5) 595-600
    CrossrefPubMedGoogle Scholar
  • 94 Winter A, Breit S, Parsch D. et al . Cartilage-like gene expression in differentiated human stem cell spheroids: a comparison of bone marrow-derived and adipose tissue-derived stromal cells.  Arthritis Rheum. 2003;  48 (2) 418-429
    CrossrefPubMedGoogle Scholar
  • 95 Behrens P, Bosch U, Bruhns J. et al . Indikations- und Durchführungsempfehlungen der Arbeitsgemeinschaft „Geweberegeneration und Gewebeersatz” zur Autologen Chondrozyten-Transplantation (ACT).  Z Orthop Ihre Grenzgeb. 2004;  142 529-539
    Article in Thieme ConnectPubMedGoogle Scholar
  • 96 Steinwachs M R, Kreuz P C. Combinations of different cartilage resurfacing techniques.  Z Orthop Ihre Grenzgeb. 2003;  141 (6) 625-628
    Article in Thieme ConnectPubMedGoogle Scholar
  • 97 Wasiak J, Clar C, Villanueva E. Autologous cartilage implantation for full thickness articular cartilage defects of the knee.  Cochrane Database Syst Rev. 2006;  3 CD003323
    PubMedGoogle Scholar
  • 98 Wasiak J, Villanueva E. Autologous cartilage implantation for full thickness articular cartilage defects of the knee.  Cochrane Database Syst Rev. 2002;  4 CD003323
    PubMedGoogle Scholar

Dr. med. Philipp Niemeyer

Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg

Hugstetter Str. 55

79095 Freiburg im Breisgau

Email: philipp.niemeyer@uniklinik-freiburg.de

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