Operativno zdravljenje okvar sklepnega hrustanca v kolenu: Surgical treatment of the knee cartilage lesions

Due to its specific structure, articular cartilage has a limited regenerative ability. Even small lesions on the articular surface progress to an osteoarthritic deformation of the joint, with the end result the implantation of an endoprosthesis: New surgical methods for knee cartilage repair were developed at the beginning of the nineties. Mosaicoplasty and transplantation of autologous chondrocytes have been widely accepted as regular clinical procedures. Mosaicoplasty is a method in which osteochondral plugs are transferred from less load-bearing areas of the joint to a defect located on the major load-bearing surface. This technique was originally used on the kneejoint, but there have also been many recent reports of its use on other joints. The major problems are cartilage availability and the patient's age. Transplantation of autologous chondrocytes is based on arthroscopic removal ofsmall cartilage pieces from the edge of the knee joint surface. Chondrocytesfrom the removed cartilage are cultivated in vitro and implanted back into the defect. Treatment of focal lesions of the femoral condyles and the patella has proved successful in young patients. Limitations include lesion size and concomitant osteoarthritic changes at the site of the defect. Both methods have yielded encouraging results for the treatment of focal chondral lesions, but the osteoarthritic type of cartilage injury remains an unsolved issue. Sklepni hrustanec ima zaradi specifične zgradbe omejeno sposobnost celjenja popoškodbah in boleznih. Že majhne, lokalizirane okvare sklepne površine lahkovodijo v razširjeno degeneracijo sklepa (artrozo), ki kasneje velikokrat zahteva zamenjavo sklepa z umetno endoprotezo. V začetku devetdesetih so se pričele razvijati nove kirurške metode za popravo poškodovanega hrustanca in zaustavitev degenerativnih sprememb v kolenskem sklepu. V razširjeni klinični uporabi sta se uveljavili mozaična plastika in vsaditev avtolognih hrustančnihcelic. Pri mozaični plastiki prenesemo kostno-hrustančne čepe z manj obremenjene površine sklepa na mesto okvare na močno obremenjenem delu. Metoda se je pričela uporabljati na kolenu in se širi tudi na ostale sklepe. Največjo omejitev predstavljata razpoložljivost hrustančnega tkiva, primernegaza presaditev, in starost bolnika. Vsaditev avtolognih hrustančnih celic je metoda, pri kateri iz kolena artroskopsko odvzamemo koščke zdravega hrustanca na robu sklepne površine. Iz njih v kuIturi namnožimo hrustančne celice ter jih vrnemo v sklep na mesto poškodbe. Dobre rezultate dosegamo pri mlajših ljudeh z omejenimi okvarami hrustanca na stegneničnem kondilu in na pogačici. Omejitve predstavljajo velikost poškodbe in difuzne degenerativne spremembe v sklepu. Obe metodi dajeta vzpodbudne rezultate pri zdravljenju lokaliziranih okvar hrustanca mlajših ljudi, medtem ko za razširjeno prizadetost hrustanca pri degenerativnih boleznih trenutno še nimamo ustrezne rešitve.