Schnettler R, Horas U, Meyer C
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Giessen und Marburg, Standort Giessen, Rudolf-Buchheim-Strasse 7, 35385, Giessen.
Orthopade. 2008 Aug;37(8):734-42. doi: 10.1007/s00132-008-1263-z.
Osteochondral transplantation is a treatment option for restoring lesions of the cartilage surface and the underlying subchondral bone. For this technique, osteochondral cylinders are taken from less loaded regions of the knee joint and brought into the defect. It is based on press-fit implantation of osteochondral cylinders that are harvested from the mediocranial or laterocranial aspect of the patellofemoral joint with subsequent stable bony integration of the transplant. Indications for osteochondral transplantation must consider clinical, radiological, and magnetic resonance aspects, and concomitant pathologies of the joint should be eliminated. Isolated grade III and IV cartilage lesions in the load-bearing area of the medial or lateral femoral condyle are considered to be ideal indications for osteochondral transplantations. Further indications are retropatellar defects and lesions of the medial aspect of the talus. The technique is established for defects from 1 cm2 to 3 cm2. At this time, osteochondral transplantation is the only surgical method to achieve long-term coverage of the defect with hyaline cartilage. Donor site morbidity at the patellofemoral joint needs to be discussed because, particularly after the harvest of several cylinders, pain syndromes can develop. Therefore, the technique should be limited to two cylinders with a maximum diameter of 12 mm and one further cylinder with a smaller diameter.
骨软骨移植是一种修复软骨表面及下方软骨下骨损伤的治疗选择。对于该技术，骨软骨柱取自膝关节负荷较小的区域并植入缺损处。它基于从髌股关节中颅侧或后颅侧获取的骨软骨柱的压配式植入，随后移植体实现稳定的骨整合。骨软骨移植的适应证必须综合考虑临床、放射学和磁共振方面的因素，并且应消除关节的伴随病变。股骨内侧髁或外侧髁负重区孤立的Ⅲ级和Ⅳ级软骨损伤被认为是骨软骨移植的理想适应证。其他适应证包括髌后缺损和距骨内侧病变。该技术适用于面积为1平方厘米至3平方厘米的缺损。目前，骨软骨移植是唯一一种能实现缺损长期被透明软骨覆盖的手术方法。髌股关节供区并发症需要进行讨论，因为特别是在获取多个骨软骨柱后，可能会出现疼痛综合征。因此，该技术应限制在两个最大直径为12毫米的骨软骨柱以及另一个直径较小的骨软骨柱。
