Department of Orthopaedics, University Medicine, 18057, Rostock, Germany.
Orthopaedic-Neurosurgery Center, Roentgenstrasse 10, 45661, Recklinghausen, Germany.
Arch Orthop Trauma Surg. 2024 Sep;144(9):3913-3923. doi: 10.1007/s00402-023-04964-1. Epub 2023 Jul 4.
Guideline-based surgical cartilage therapy for focal cartilage damage offers highly effective possibilities to sustainably reduce patients' complaints and to prevent or at least delay the development of early osteoarthritis. In the knee joint, it has the potential to reduce almost a quarter of the arthroses requiring joint replacement caused by cartilage damage. Biologically effective injection therapies could further improve these results. Based on the currently available literature and preclinical studies, intra- and postoperative injectables may have a positive effect of platelet-rich plasma/fibrin (PRP/PRF) and hyaluronic acid (HA) on cartilage regeneration and, in the case of HA injections, also on the clinical outcome can be assumed. The role of a combination therapy with use of intra-articular corticosteroids is lacking in the absence of adequate study data and cannot be defined yet. With regard to adipose tissue-based cell therapy, the current scientific data do not yet justify any recommendation for its use. Further studies also regarding application intervals, timing and differences in different joints are required.
基于指南的手术软骨疗法为局灶性软骨损伤提供了高度有效的可能性,可持久减轻患者的不适,并预防或至少延迟早期骨关节炎的发展。在膝关节中,它有可能减少近四分之一因软骨损伤而需要关节置换的关节炎。生物有效注射疗法可以进一步改善这些结果。基于目前的文献和临床前研究,富血小板血浆/纤维蛋白(PRP/PRF)和透明质酸(HA)的关节内和术后注射剂可能对软骨再生有积极影响,在 HA 注射的情况下,对临床结果也有积极影响。在缺乏足够的研究数据的情况下,关节内皮质类固醇联合治疗的作用尚不清楚,目前还无法确定。关于脂肪组织来源的细胞疗法,目前的科学数据还不能证明其使用的任何建议。还需要进一步研究,包括应用间隔、时机和不同关节之间的差异。