Stellenwert der autologen Chondrozytentransplantation (ACT) in der Behandlung von Knorpelschäden des Kniegelenks – Empfehlungen der AG Klinische Geweberegeneration der DGOU

 

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Zusammenfassung

Die autologe Chondrozytentransplantation oder -implantation (ACT/ACI) stellt ein anerkanntes und etabliertes Verfahren zur Behandlung lokalisiert vollschichtiger Knorpelschäden des Kniegelenks dar. Die vorliegende Übersichtsarbeit der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) beschreibt zunächst die Biologie und Funktionsweise des gesunden Gelenkknorpels, die aktuelle Kenntnislage zu den möglichen Folgen eines primären Knorpelschadens und anschließend den geeigneten Indikationsbereich der ACT. Zusammenfassend besteht vor dem Hintergrund der derzeitigen Evidenzlage die Indikation zur ACT bei symptomatischen Knorpelschäden ab einer Defektgröße von 3–4 cm², bei jungen und sportlich aktiven Patienten ab 2,5 cm². Fortgeschrittene degenerative Gelenkveränderungen stellen die wichtigste Kontraindikation dar. Neben wissenschaftlichen Grundlagen werden die Ergebnisse klinischer Studien, sowie die Vor- und Nachteile der ACT im Rahmen dieser Übersicht dargestellt und diskutiert.

Abstract

Autologous chondrocyte transplantation/implantation (ACT/ACI) is an established and recognised procedure for the treatment of localised full-thickness cartilage defects of the knee. The present review of the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Traumatology (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning potential consequences of primary cartilage lesions and the suitable indication for ACI. Based on current evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than 3–4 cm²; in the case of young and active sports patients at 2.5 cm². Advanced degenerative joint disease is the single most important contraindication. The review gives a concise overview on important scientific background, the results of clinical studies and discusses advantages and disadvantages of ACI.

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