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Biologische Knorpelersatztherapieverfahren an der Schulter

Technik, Indikationen und Grenzen

Biologic options for treatment of cartilage lesions at the shoulder joint

Technique, indications and limits

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die Therapie fokaler Knorpelschäden stellt den Schulterchirurgen vor mehrere Herausforderungen. Zum einen handelt es sich oft um Zufallsbefunde, die neben anderen Pathologien gerade am Schultergelenk als Kombination auftreten. Auch die präoperative Diagnostik ist in der Routine oft insuffizient, um das genaue Ausmaß von Knorpelläsionen klar darzustellen. Schlussendlich ist die Evidenzlage in Bezug auf mögliche Therapien noch ausgesprochen schwach. Es liegen nur Studien mit sehr niedrigen Fallzahlen und kurzem Follow-up vor. Erschwerend kommt hinzu, dass viele Läsionen schon Bild einer Früharthrose sind oder die kombinierte Pathologie in diesen Studien adressiert wurde, sodass es schwer ist, klare Strategien abzuleiten. Moderne arthroskopische Verfahren erlauben heute allerdings vielversprechende Therapien, die nun auch minimal-invasiv angewendet werden können und eventuell die Möglichkeit der Bildung eines Knorpelersatzgewebes geben.

Abstract

The treatment of focal cartilage defects confronts the shoulder surgeon with several challenges. It is often an incidental finding that occurs in combination with other pathologies, particularly in the shoulder joint. In addition, the preoperative diagnostics are often insufficient in the routine practice to clearly show the exact extent of cartilage lesions. Ultimately, the evidence base with respect to possible treatment options is still extremely weak. Only studies with very low case numbers and short follow-up are available. A further complicating factor is that many lesions are already evidence of an early osteoarthritis or the combined pathology was addressed in these studies, making it difficult to derive clear strategies; however, modern arthroscopic procedures enable promising forms of treatment that can be applied in a minimally invasive way and may even provide the possibility of formation of cartilage replacement tissue.

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Authors and Affiliations

  1. ATOS Orthoparc Klinik Köln, Aachenerstr. 1021B, 50858, Köln, Deutschland

    A. Franz B.Sc. &  K. Beitzel

  2. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, 40225, Düsseldorf, Deutschland

    B. Bittersohl

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Interessenkonflikt

K. Beitzel weist auf folgende Beziehung hin: Consultant für Arthrex Inc. A. Franz und B. Bittersohl geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Franz, A., Bittersohl, B. & Beitzel, K. Biologische Knorpelersatztherapieverfahren an der Schulter. Arthroskopie 33, 329–335 (2020). https://doi.org/10.1007/s00142-020-00387-x

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