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Autologe Chondrozytentransplantation am oberen Sprunggelenk

Rational oder irrational?

Autologous chondrocyte transplantation in the ankle joint

Rational or irrational?

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Zusammenfassung

Distorsionen des oberen Sprunggelenks (OSG) gehören zu den häufigsten Verletzungen der unteren Extremität. Dabei kann es zu gelenknahen Fakturen, medialen oder lateralen Bandläsionen und Knorpelschäden kommen. Die oft praktizierte Bagatellisierung dieser Verletzung mit minimalem Einsatz bildgebender Verfahren führt dazu, dass intraartikuläre Verletzungen gelegentlich erst nach Wochen oder Monaten adäquat dargestellt und behandelt werden. Liegt eine symptomatische osteochondrale Läsion des Talus vor, die kernspintomographisch und gelegentlich sogar röntgenologisch gut darstellbar ist, besteht v. a. bei jungen und körperlich aktiven Patienten die Indikation zur operativen Intervention.

Prinzipiell stehen die Methoden der Mikrofrakturierung, der Mosaikplastik und der autologen Chondrozytentransplantation (ACT) zur Verfügung. Letztere wurde bislang vorzugsweise am Kniegelenk eingesetzt und stellt hier die Methode der Wahl bei großen Knorpeldefekten dar. Aufgrund der guten Ergebnisse im Kniegelenk und der technischen Verbesserungen (dreidimensionale Gewebekonstrukte mit autologen Chondrozyten) wird das Verfahren zunehmend auch bei Knorpelläsionen des Talus angewendet. Im Gegensatz zur Mosaikplastik ist die Entnahmemorbidität gering und die Größe des Defekts daher nicht limitierend.

Die wenigen vorliegenden Studien zur ACT am Talus zeigen eine stabile Defektsanierung mit überwiegend hyalinähnlichem Knorpel und hoher subjektiver Patientenzufriedenheit, sodass dieses Verfahren ab einer Defektgröße von >1 cm2 empfohlen werden kann. Die Mitbehandlung von posttraumatischen Deformitäten (z. B. Achsenfehlstellungen), ligamentären Instabilitäten und insbesondere die gleichzeitige Rekonstruktion von knöchernen Defekten sind unabdingbare Voraussetzungen.

Abstract

Ankle sprains are one the most common injuries of the lower limb. Fractures, ligamentous lesions, and cartilaginous damage are often associated. Nevertheless the injury is often misjudged and concomitant chondral lesions are assessed late. In the case of a symptomatic osteocartilaginous lesion of the talus, which can be illustrated by MRI or X-ray, operative intervention is indicated.

Methods such as microfracturing, mosaicplasty, and autologous chondrocyte transplantation (ACT) are in clinical use. The latter is well known and being established as the treatment of choice for large cartilage defects in the knee. Due to the good results in the knee and the technological improvements (three-dimensional tissue constructs seeded with autologous chondrocytes) this method is being increasingly applied for cartilage lesions of the talus.

In contrast to the mosaicplasty donor site morbidity is low and the size of the defect is not a limiting factor. The current studies about ACT of the talus show a stable repair of the defect with mostly hyaline-like cartilage and high patient satisfaction. Therefore, the procedure can be recommended for lesions >1 cm2. Concomitant treatment of posttraumatic deformities (malalignment), ligamentous instabilities, and especially the reconstruction of bony defects are compulsory.

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Authors and Affiliations

  1. Lehrstuhl für Orthopädie , Friedrich-Schiller-Universität Jena am Waldkrankenhaus „Rudolf-Elle“, Eisenberg, Deutschland

    M. Aurich, R.A. Venbrocks & R.A. Fuhrmann

  2. Department of Trauma Surgery, The ALFRED Hospital, Commercial Road, Melbourne, VIC 3004, Australien

    M. Aurich

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  1. M. Aurich
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  2. R.A. Venbrocks
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  3. R.A. Fuhrmann
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Correspondence to M. Aurich.

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Aurich, M., Venbrocks, R. & Fuhrmann, R. Autologe Chondrozytentransplantation am oberen Sprunggelenk. Orthopäde 37, 188–195 (2008). https://doi.org/10.1007/s00132-008-1210-z

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