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Die Diagnose „Knorpelschaden am Knie“ weckt schlimme Befürchtungen. Doch dank moderner Operationsverfahren ist für viele Sportler eine Rückkehr zum Sport möglich.

To evaluate the safety and efficacy of matrix-associated autologous chondrocyte implantation (ACI) using spheroids in comparison to arthroscopic microfracture for the treatment of symptomatic cartilage defects of the knee.In a prospective multicenter-controlled trial, patients aged between 18 and 50 years, with single symptomatic focal cartilage defects between 1 and 4 cmThe overall KOOS and its five subscores were significantly improved compared to baseline for both the ACI and microfracture group. Non-inferiority of ACI to microfracture was confirmed for the overall KOOS and the subscores, while for the subscores activities of daily living, quality of life and sports and recreation of the threshold for superiority was passed. In the ACI group, a notably more rapid initial improvement of the KOOS was found at three months for the older age group compared to the younger age group and the microfracture group. No other differences were found based on age or defect size. In addition, clinical improvement was found for the MOCART, modified Lysholm and IKDC examination form both the ACI and microfracture group. No safety concern related to either treatment was observed.This study confirms the safety and efficacy of matrix-associated ACI with spheroids at a mid to long-term follow-up. Non-inferiority of ACI to microfracture was confirmed for the overall KOOS and all subscores, while superiority was reached for the subscores activities of daily living, quality of life and sports and recreation in the ACI group. This underlines the importance of ACI for the young and active patients.I.

Background: Autologous chondrocyte implantation (ACI) is an established procedure for the treatment of cartilage damage in the knee joint. At present, it is still unclear how previous surgery influences outcome after ACI. Purpose: To evaluate the effect of previous knee surgery related or nonrelated to the treated cartilage defect on clinical outcome after ACI for knee cartilage defects. Study Design: Cohort study; Level of evidence, 3. Methods: An overall 730 patients with ACI who underwent previous unspecific knee surgery, whether related to the defect being currently treated or not, were identified from a cohort of 5961 patients registered in the German Cartilage Registry. Propensity score matching was used to match these patients to 690 patients with analogous characteristics but without previous surgery. Subsequently, 317 patients with previously failed cartilage treatment at the defect site were identified and compared with a matched collective of 254 patients without previous cartilage treatment. In a subgroup analysis, the type of previous cartilage surgery was additionally investigated. Outcome was evaluated by Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, rate of reintervention, and patient satisfaction up to 36 months. A chi-square test was used to compare categorial variables and an unpaired t test to compare continuous variables. Results: Patients with previous knee surgery not related to the cartilage defect showed a lower KOOS at 6 months (68.3 vs 70.8; P = .026), while patients with previous cartilage surgery showed significantly lower KOOS values at all follow-up time points when compared with patients without any previous knee or cartilage surgery (all P < .05). A comparison of KOOS values in patients with previous therapy at the cartilage defect with ACI versus bone marrow stimulation did not show any significant differences at any follow-up. Conclusion: Previously failed cartilage treatment at the defect site represents a negative prognostic factor up to 3 years after ACI. However, this influence appears to be independent of the type of previous treatment at the defect site and applies equally to failed bone marrow stimulation as well as previous ACI. In contrast, a negative effect of previous surgery to the knee unrelated to the cartilage defect could not be shown in the 3-year follow-up.

Prospektiv-randomisierte klinische Studien (RCTs) gelten fur die Durchfuhrung chirurgischer Studien als Goldstandard und stehen fur das hochste Evidenzlevel in der Medizin. Bedingt auch durch die Notwendigkeit von Studien fur die Zulassung autologer Zelltherapien liegt im Bereich der Knorpelchirurgie eine Vielzahl prospektiv-randomisierter Studien vor. Die Durchsicht und Analyse dieser Studien bringt viele wichtige Erkenntnisse. Dennoch zeigt die Datenlage, gerade im Bereich der Knorpelchirurgie, auch die Limitationen der alleinigen Analyse prospektiv-randomisierter Studien, die viele klinisch relevante Fragestellungen nicht beantworten konnen. Der vorliegende Artikel diskutiert und analysiert auf Basis der Evidenzlage im Bereich der knorpelregenerativen Therapie am Kniegelenk die Vor- und Nachteile prospektiv-randomisierter Studien im Vergleich zu longitudinalen Oberservationsstudien (z. B. klinische Behandlungsregister) und pladiert fur eine Adaptation der Festlegung der Evidenzlevel in Abhangigkeit der konkreten Fragestellung. Grundlage fur diesen Artikel stellen die Daten aus dem KnorpelRegister DGOU dar, welches im Oktober 2013 eingefuhrt wurde und mittlerweile mehr als 10.000 prospektiv erfasste Datensatze beinhaltet.

Die operative Therapie von Knorpelschäden am Kniegelenk hat sich in den letzten Jahren von vorsichtigen Anfängen mit innovativen Therapieansätzen zu einem festen und etablierten Baustein der gelenkerhaltenden Therapie entwickelt. Hingegen hat sich am Hüftgelenk erst in den letzten 10 Jahren, basierend auf einem erweiterten Verständnis grundlegender mechanischer Pathomechanismen, die gelenkerhaltende Hüftchirurgie und insbesondere die Knorpeltherapie etabliert. Der Beitrag stellt die zur Verfügung stehenden Techniken vor.

Smoking is known to have various deleterious effects on health. However, it is not clear whether smoking negatively affects the postoperative outcome following matrix-based autologous cartilage implantation (MACI) in the knee. The purpose of this study was to evaluate the effect of smoking on the outcome of MACI in the knee. A total of 281 patients receiving MACI in the knee between 2015 and 2018 were registered in the German Cartilage Database. The cohort was divided into ex-smokers, smokers, and nonsmokers. Data regarding the Knee Injury and Osteoarthritis Outcome Score (KOOS), the numeric rating scale (NRS) for pain, and satisfaction with the outcome were analyzed and compared. Follow-ups were performed at 6, 12, and 24 months after surgery. Of the 281 patients, 225 (80.1%) were nonsmokers, 43 (15.3%) were smokers, and 13 (4.6%) were ex-smokers. The three groups were comparable with respect to age, sex, body mass index (BMI), height, defect size, the need for additional reconstruction of the subchondral bone defect, number of previous knee surgeries, and defect location. However, nonsmokers had a significantly lower weight as compared with smokers. Besides a significantly lower preoperative NRS of nonsmokers as compared with smokers, there were no significant differences between the three groups with respect to KOOS, NRS, and satisfaction at 6, 12, and 24 months of follow-ups. The present study of data retrieved from the German Cartilage Registry suggests that the smoking status does not influence the outcome of MACI in the knee.

Purpose To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. Methods All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. Results A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. Conclusion Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. Level of evidence Retrospective case series, Level IV.

Purpose The German Arthroscopy Registry (DART) has been initiated in 2017 with the aim to collect real-life data of patients undergoing knee, shoulder, hip or ankle surgery. The purpose of this study was to present an overview of the current status and the collected data thus far. Methods Data entered between 11/2017 and 01/2022 were analyzed. The number of cases (each case is defined as a single operation with or without concomitant procedures) entered for each joint, follow-up rates and trends between different age groups (18–29 years, 30–44 years, 45–64 years, ≥ 65 years) and across genders, and quality of life improvement (pre- vs. 1 year postoperative EQ visual analogue scale [EQ-VAS]) for frequently performed procedures (medial meniscus repair [MMR] vs. rotator cuff repair [RCR] vs. microfracturing of the talus [MFX-T]) were investigated. Results Overall, 6651 cases were entered into DART, forming three distinct modules classified by joint (5370 knee, 1053 shoulder and 228 ankle cases). The most commonly entered procedures were: knee: partial medial meniscectomy (n = 2089), chondroplasty (n = 1389), anterior cruicate ligament reconstruction with hamstring autograft (n = 880); shoulder: sub acromial decompression (n = 631), bursectomy (n = 385), RCR (n = 359); ankle: partial synovectomy (n = 117), tibial osteophyte resection (n = 72), loose body removal (n = 48). In the knee and shoulder modules, middle-aged patients were the predominant age group, whereas in the ankle module, the youngest age group was the most frequent one. The two oldest age groups had the highest 1-year follow-up rates across all modules. In the knee and shoulder module, 1-year follow-up rates were higher in female patients, whereas follow-up rates were higher in male patients in the ankle module. From pre- to 1-year postoperative, MFX-T (EQ-VAS: 50.0 [25–75% interquartile range: 31.8–71.5] to 75.0 [54.3–84.3]; ∆ + 25.0) led to a comparably larger improvement in quality of life than did MMR (EQ-VAS: 70.0 [50.0–80.0] to 85.0 [70.0–94.0]; ∆ + 15.0) or RCR (EQ-VAS: 67.0 [50.0–80.0] to 85.0 [70.0–95.0]; ∆ + 18.0). Conclusion DART has been sufficiently established and collects high-quality patient-related data with satisfactory follow-up allowing for a comprehensive analysis of the collected data. The current focus lies on improving patient enrolment and follow-up rates as well as initiating the hip module.

The goal was to examine gender differences of patient characteristics and outcome after cartilage repair based on a collective of nearly 5,000 patients. Patient characteristics, accompanying therapies, and outcome (Knee Injury and Osteoarthritis Outcome Score [KOOS], reoperations, patient satisfaction) of 4,986 patients of the German cartilage register DGOU were assessed by t test for possible gender differences. P values

Zusammenfassung Die „Stammzelltherapie“ ist in aller Munde; nicht nur im wissenschaftlichen Kontext, sondern auch im popularwissenschaftlichen, sodass das Interesse und auch die Hoffnungen auf Arzt- und Patientenseite gros sind. Potentiell besitzen Stammzellen ein groses Indikationsspektrum, das neben der Knorpel- auch die Meniskus- und Bandregeneration miteinschliest. Fur letztere Indikationen liegen zwar praklinische und vereinzelte klinische Studien vor, jedoch werden hier einerseits sehr unterschiedliche Konzepte verfolgt und andererseits liegt eine grose Heterogenitat der applizierten Zellen und eine Unscharfe der Terminologie der Stammzelle vor, sodass die ersten Ergebnisse als vielversprechend eingestuft werden konnen, es aber noch kontrollierter Studien bedarf, bevor diese Therapien fur die Meniskus- und Bandregeneration in den klinischen Alltag Einzug erhalten. Im Vergleich zu Anwendungen an den Menisken und dem Bandapparat ist die Anwendung von „Stammzellen“ zur Behandlung von fokalen Knorpelschaden – wo im Vergleich zur etablierten ACT (Autologen Chondrozyten Transplantation) vergleichbare Ergebnisse gezeigt werden konnten – und der Arthrose besser untersucht und weiterverbreitet, weshalb im Folgenden auf die Injektionstherapie bei Arthrose im Detail eingegangen werden soll.

Die Behandlung unterschiedlichster Pathologien am Kniegelenk mit sog. Stammzelltherapien ist in aller Munde und weckt sowohl auf Seiten der Arzte als auch auf Seiten der Patienten grose Hoffnungen. Potenzielle Anwendungsfelder sind hierbei mannigfaltig und gepragt durch unterschiedliche Moglichkeiten in der Aufbereitung von Zell- und Gewebeprodukten. Durch eine strenge Regulation solcher Therapieverfahren besteht jedoch eine sehr heterogene Situation in Bezug auf verschiedene Arten der Zelltherapie und unterschiedlichen Indikationen. Wahrend in der initialen Phase die wissenschaftliche Evidenz limitiert war, beginnt diese sich gerade bei der Anwendung expandierter Zellen zur Behandlung von Knorpelschaden und Arthrose deutlich zu bessern. Der vorliegende Artikel gibt eine Ubersicht uber potenzielle Indikationsfelder zum Einsatz von Stammzelltherapien am Kniegelenk und versucht, die zur Verfugung stehenden Prinzipien der Anwendung von Zell- und Gewebeaufbereitungen aus verschiedenen Ursprungsgeweben mit dem Schwerpunkt auf Knochenmark und Fettgewebe zu systematisieren.

Fokale Knorpelschaden am Kniegelenk fuhren zu einer eingeschrankten Gelenkfunktion und Reduktion der Lebensqualitat. Zudem stellen sie einen Risikofaktor fur das Voranschreiten und Auftreten einer Arthrose dar. Vor diesem Hintergrund kommt ihrer Behandlung eine grose medizinische, aber auch soziookonomische Bedeutung zu. In den vergangenen Jahren hat sich die Knorpeltherapie als fester Baustein in der Orthopadie etabliert und auch zunehmend an wissenschaftlicher Evidenz gewonnen. Der vorliegende Ubersichtsartikel gibt eine Ubersicht uber die aktuellen Therapieoptionen im Bereich der knorpelregenerativen Therapie am Kniegelenk inklusive des Aspektes der Nachbehandlung.

Background Inadequate reactions to unforeseen external stimuli are regarded as a major cause for non-contact anterior cruciate ligament (ACL) injuries. We aimed to delineate a potential deficit in the ability to perform unanticipated jump-landing manoeuvres, its sustainability and potential as a new outcome measure after ACL-reconstruction. Methods Physically active adults (n = 27, 13 females, 14 males, 29.7 standard deviation 3.1 years) with a history of unilateral ACL rupture and subsequent reconstruction (6 months to 7 years ago), cleared for return to sports, were included. All participants performed counter-movement jumps with unanticipated single leg landings. Visual information shown after jump take-off indicated the required landing leg. Jump time [s] and successfulness [yes/no], vertical peak ground reaction forces at landing [N], as well as time to stabilisation after landing [s] and path length of the centre of pressure (CoP, [mm]) were calculated. Limb symmetry ratios were determined and analysed for their association with the time since surgery. Findings Time since ACL reconstruction was logarithmically (basis 10) associated with side symmetry improvements in peak ground reaction force (R2 = 0.23, p Interpretation A deficit in unanticipated jump-landing ability seems to persist far beyond surgical restoration of mechanical stability and resumption of initial physical activities levels. The assessment of the ability to suddenly adapt movements to unanticipated visual stimuli may be a relevant complementary component within current functional testing canon in monitoring therapy success and return to sport testing.

Background: Good-to-excellent midterm results after high tibial osteotomy (HTO) to treat medial compartment cartilage defects or osteoarthritis (OA) have been published, but little is known about long-term survival rates in terms of conversion to total knee arthroplasty (TKA) using angular stable internal plate fixation. Purpose: To determine TKA-free survival rates and functional and radiological outcomes at 10 years after HTO. A subgroup analysis of patients who underwent combined HTO and autologous cartilage implantation (ACI) was also performed. Study Design: Case series; Level of evidence, 4. Methods: Included were 125 patients with a mean follow-up of 9.90 ± 2.25 years; 90 patients underwent HTO for medial OA, and 35 patients underwent ACI and HTO for medial focal cartilage defects. Functional outcome measures included visual analog scale (VAS) for pain, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and KOOS4 (average of 4 KOOS subscales: Pain, Symptoms, Sport, and Quality of Life). Radiological outcomes included lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle. Results: Overall, 16 patients required conversion to TKA at a mean 86.75 ± 25.73 months (10-year survival rate, 87.2%). Only 2 patients in the HTO+ACI subgroup required a conversion to TKA (10-year survival rate, 94.3%). The complication rate for all patients was 8.8%. In both the HTO and HTO+ACI subgroups, VAS pain levels decreased and Lysholm scores increased significantly from pre- to postoperatively ( P < .001). A higher preoperative Tegner score led to a significantly lower risk for conversion to TKA ( P = .001), and a preoperative body mass index of ≥35 was associated with a significantly higher risk ( P = .019), as was female sex ( P = .046). Radiological parameters remained within physiological ranges. The postoperative joint line conversion angle did correlate with postoperative functional outcome but not with TKA conversion. Conclusion: Long-term results of HTO for medial compartment OA or cartilage defects with underlying varus deformity were good to excellent. In particular, patients who underwent HTO+ACI presented excellent long-term survival rates. HTO, therefore, delays or prevents TKA implantation, especially in young, active patients with medial compartment damage.

The Working Group of the German Orthopedic and Trauma Society (DGOU) on Tissue Regeneration has published recommendations on the indication of different surgical approaches for treatment of full-thickness cartilage defects in the knee joint in 2004, 2013 and 2016. Based upon new scientific knowledge and new developments, this recommendation is an update based upon the best clinical evidence available. In addition to prospective randomised controlled clinical trials, this also includes studies with a lower level of evidence. In the absence of evidence, the decision is based on a consensus process within the members of the working group.The principle of making decision dependent on defect size has not been changed in the new recommendation either. The indication for arthroscopic microfracturing has been reduced up to a defect size of 2 cmDie Arbeitsgemeinschaft „Klinische Geweberegeneration“ hat bereits in den Jahren 2004, 2013 und 2016 Empfehlungen in Bezug auf die Indikation für verschiedene knorpelregenerative Verfahren zur Behandlung von Knorpelschäden am Kniegelenk publiziert. Auf Basis neuer wissenschaftlicher Erkenntnisse sollen in der vorliegenden Arbeit diese Empfehlungen auch unter Einbeziehung neuer Behandlungsverfahren aktualisiert werden. Die Einschätzung folgt damit dem Prinzip der besten verfügbaren Evidenz und berücksichtigt über prospektiv randomisierte Studien hinaus auch Studien mit niedrigerem Evidenzniveau. An Stellen fehlender publizierter Evidenz basiert die Entscheidung hier auf einem Konsensusprozess innerhalb der Mitglieder der AG Klinische Geweberegeneration.Das Prinzip der bereits vorausgehend publizierten Arbeiten bleibt auch in den neuen Empfehlungen erhalten. Kleine Knorpelschäden sind nach Ansicht der Arbeitsgruppe für eine Knochenmarkstimulation zugänglich, die matrixassoziierte autologe Chondrozytentransplantation (mACT) ist für größere Knorpelschäden die Methode der Wahl. Auf Basis neuerer Daten wird jedoch die Indikationsgrenze für die mACT auf 2,0 cm

The working group, “Clinical Tissue Regeneration” of the German Society of Orthopedics and Traumatology (DGOU) issues this paper to update their guidelines. Methods Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. Conclusion In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.

Membrane contact sites (MCS) are inter-organellar connections that allow for the direct exchange of molecules, such as lipids or Ca2+ between organelles, but can also serve to tether organelles at specific locations within cells. Here we identified and characterised three proteins that form a lipid droplet (LD)-plasma membrane (PM) tethering complex in plant cells, namely LD-localised SEED LD PROTEIN (SLDP) 1 and 2 and PM-localised LD-PLASMA MEMBRANE ADAPTOR (LIPA). Using proteomics and different protein-protein interaction assays, we show that both SLDPs associate with LIPA. Disruption of either SLDP1 and 2 expression, or that of LIPA, leads to an aberrant clustering of LDs in Arabidopsis seedlings. Ectopic co-expression of one of the SLDPs with LIPA on the other hand is sufficient to reconstitute LD-PM tethering in Nicotiana tabacum pollen tubes, a cell type characterised by dynamically moving LDs in the cytosolic streaming. Further, confocal laser scanning microscopy revealed both SLDP2.1 and LIPA to be enriched at LD-PM contact sites in seedlings. These and other results suggest that SLDP and LIPA interact to form a tethering complex that anchors a subset of LDs to the PM during post-germinative seedling growth in Arabidopsis thaliana.One-sentence summarySEED LIPID DROPLET PROTEIN1 and 2 and LIPID DROPLET PLASMA MEMBRANE ADAPTOR tether lipid droplets to the plasma membrane in seedlings of Arabidopsis thaliana.

This study aims to report on a prospectively collected, multicenter database of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) and concomitant cartilage damage (according to the International Cartilage Repair Society) and to assess the outcome-affecting parameters. In the study, 353 hips with up to 24 months’ follow-up were assessed by iHOT-33 scoring and achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) levels. Multiple and binary regression analyses were performed to identify factors related to (un-) favorable outcomes and to assess their clinical relevance with regard to achieving the MCID and PASS. Multiple regression yielded the parameters of male sex (p = 0.022) and lower body mass index (BMI) (p = 0.019) at 6 months, lower BMI (p = 0.022) and younger age (p = 0.022) at 12 months, and younger age at 24 months (p = 0.039) to be significantly associated with higher iHOT scoring. Male sex (p = 0.019) and lower BMI (p = 0.018) were significantly correlated with achievement of the PASS in binary regression at 6 months, whereas at 12 (p = 0.010) and at 24 (p = 0.003) only younger age was shown to be significantly correlated. None of the parameters was statistically associated with achievement of the MCID. As the parameters of younger age, male sex, and lower BMI were identified as temporarily correlated with a preferable outcome in general and with achievement of the PASS in particular, these findings help to preoperatively identify factors associated with (un-) favorable therapy results.

The aim of this study was to investigate the effect of product dose in autologous chondrocyte implantation (ACI) for the treatment of full-thickness cartilage defects of the knee and to assess its influence on clinical and morphological mid-term outcome. Seventy-five patients were included in this single-blind, randomised, prospective, controlled clinical trial. Patients were assigned randomly to three different dose groups [low (3–7 spheroids/cm2), medium (10–30 spheroids/cm2), or high (40–70 spheroids/cm2)] and assessed using standardised clinical and morphological scoring systems (KOOS, IKDC, MOCART) for 4 years following the intervention. The analysis population comprised 75 patients (22 women, 53 men) aged 34 ± 9 years. Defect sizes ranged from 2 to 10 cm2 following intraoperative debridement. The assessment of the primary variable ‘overall KOOS’ showed a statistically significant improvement, compared with baseline, for each dose group, i.e., at baseline the mean ‘overall KOOS’ scores were 60.4 ± 13.6, 59.6 ± 15.4, and 51.1 ± 15.4 for the low-, medium-, and high-dose groups, respectively, and 57.0 ± 15.2 for ‘all patients’. After 48 months those values improved to 80.0 ± 14.7, 84.0 ± 14.9, and 66.9 ± 21.5 in the respective dose groups and 77.1 ± 18.6 for ‘all patients’. Pairwise comparisons of these dose groups did not reveal any statistically significant differences. Likewise, assessment of the subjective IKDC score revealed no statistically significant differences between the three dose groups up to the 48-month visit. However, between 12 and 48 months there was a low, but steady, improvement in the low-dose group and a substantial amelioration in the medium-dose group. The mean MOCART total scores 3 months after treatment were 59.8 ± 10.9, 64.5 ± 10.3, and 64.7 ± 9.4 for the low-, medium-, and high-dose groups, and 62.9 ± 10.3 for ‘all patients’; 48 months after treatment these were 73.9 ± 13.1, 78.0 ± 12.4, and 74.3 ± 14.0 for the respective dose groups and 75.5 ± 13.1 for ‘all patients’. Results of this study confirm the efficacy and safety of the applied “advanced therapy medicinal product”; no dose dependence was found either for the incidence or for the severity of any adverse reactions. All doses applied in the present study led to significant clinical improvement over time and can therefore be regarded as effective doses. The influence of product doses in the range investigated seems to be low and can be neglected. Thus, the authorised dose range of 10–70 spheroids/cm2 confirmed by this clinical trial offers a broad therapeutic window for the surgeon applying the product, thereby reducing the risk of over- or underdosing. I.

Introduction Focal cartilage defects of the knee are often treated with arthroscopic debridement. Existing literature discussing the benefit of debridement for small articular cartilage lesions is scarce, especially if the debridement was not part of a combined operative cartilage procedure including meniscal and ligament repair. The purpose of this study was to examine the patients´ benefit after arthroscopic debridement for the treatment of isolated focal chondral defects with or without partial meniscus resection. Materials and methods Baseline (preoperative data) and 12-month follow-up of the five Knee Osteoarthritis Outcome Score (KOOS) subscores and the Numeric Rating Scale (NRS) for pain were analyzed in 126 patients undergoing debridement for focal chondral defects of the knee from the German Cartilage Registry. Sub-analysis for patients receiving isolated debridement and debridement with concomitant partial resection of meniscal pathologies was performed. Thus, four subgroups were created according to the treated defect size and presence of meniscal pathologies: “debridement-only 2”, “debridement-only > 2 cm2”, “debridement and partial meniscus resection 2” and “debridement and partial meniscus resection > 2 cm2”. Results KOOS-subscores showed a significant increase from baseline to follow-up evaluation (p = 0.017–0.037) within the 126 patients. Sub-analysis showed significant improvement of all five KOOS-subscores in all three subgroups, except for the “debridement and partial meniscus resection > 2 cm2”—group: in this group the KOOS subscores symptoms and sports showed no significant improvement. The NRS scores revealed no significant changes from baseline to 12-month follow-up within the four subgroups. Conclusion An overall benefit of arthroscopic debridement for focal cartilage lesions of the knee could be conducted. Isolated cartilage defects seem to benefit from debridement irrespectively of size. In patients with large cartilage defects (> 2 cm2) and concurrent meniscal pathology expectation to improvement should be humbled. Effective reduction of pain by arthroscopic debridement remains unclear.

Stammzelltherapie zur Behandlung von Knorpelschaden und Arthrose ist in aller Munde und stellt fur den Arzt, aber auch fur viele Patienten einen hochst attraktiv anmutenden Therapieansatz mit hohem Innovationsgrad dar. Dennoch erscheint der Bereich der Zelltherapie nicht unproblematisch. So sind Zell- und Gewebstherapeutika in Deutschland durch die Verordnung von Arzneimitteln fur neuartige Therapieansatze (ATMP) im Sinne des Arzneimittelgesetzes reguliert, und es besteht eine grose Heterogenitat bei den Anwendungsmoglichkeiten. Zudem lasst sich die aktuell verfugbare geringe wissenschaftliche Evidenz nur schwer einordnen. Nicht nur vor diesem Hintergrund sind aus Sicht der Autoren hier kontrollierte Studien mit spezifischen Fragestellungen zu fordern, bevor diese Therapieansatze den Patienten in der Breite angeboten werden. Der vorliegende Artikel umfasst die unterschiedlichen Aspekte der aktuellen Problematik in Bezug auf die Anwendung von Zell- und Gewebetherapien in Deutschland.

This study was aimed to determine the impact of bioregenerative operations in case of degenerative cartilage lesions within the media knee compartment.The CartilageRegistry DGOU was founded in 2013. At the deadline August 2016 a total of 1847 patients were included. A total of 23.3% (n = 432) was suffering from a degenerative cartilage lesion in the medial compartment. Follow-up was performed after 6, 12, and 24 months (online evaluation). The patients were asked for their subject feeling as well as the KOOS (Knee injury and Osteoarthritis Outcome Score) was determined.Most of the patients (n = 358) suffered from a single femoral lesion. In 25 cases single tibial and in 49 cases combined defects ("kissing lesions") were addressed by different treatment options: 39.9% autologous chondrocyte transplantation, in 8.1% in combination with a spongiosa plasty. Other treatments were drilling, microfracturing with or without matrix. In 17.9% the surgeons had chosen combined methods. The bioregenerative treatment was combined with a concomitant operation in 39.7% in patients with medial, in 56.0% in patients with a tibial, and in 67.9% in patients with combined defects. The mostly performed additional operations were osteotomies. There were no gender differences at baseline or during follow-up. The history of patients with femoral defects was shorter than in the other groups. The patients with medial defects judged the subjective outcome significant more frequently better after 6, 12, or 24 months compared with the other groups. The KOOS raised from baseline (median 52 points) to a median of 75 after 6, to 78 points after 12, and to 80 points after 24 months. Patients with femoral defects had a better KOOS-outcome in tendency. Revision operations were required in 7.1%.The treatment of degenerative cartilage lesions (respective early OA) by bioregenerative procedures are well-established measures. These treatments are sufficient to produce high patients' satisfaction and acceptable short/midterm results.Degenerativ bedingte Knorpelschäden im medialen Kniekompartiment. Assoziierte Faktoren, operative Optionen und präliminäre Ergebnisse. Ergebnisse aus dem KnorpelRegister (DGOU).Ziel dieser Untersuchung war es, den Stellenwert der knorpelregenerativen Behandlungen bei Patienten mit degenerativ bedingten Knorpelschäden des Kniegelenkes, vor allem bei Vorliegen von kombinierten Defekten, unter dem Aspekt der Versorgungsforschung anhand der Daten aus dem KnorpelRegister in Deutschland zu untersuchen.Das KnorpelRegister (DGOU) besteht seit dem Jahre 2013. Bis August 2016 wurden im Kniemodul des Registers insgesamt 1847 Behandlungsfälle erfasst, von denen 432 Patienten (23,3%) degenerativ bedingte Knorpelschäden im Bereich des medialen Kompartiments aufwiesen. Entsprechend den Präferenzen der verschiedenen an der Erfassung beteiligten Einrichtungen wurden bei diesen Patienten verschiedene Verfahren der knorpelregenerativen Therapie angewandt. Die Kontrolluntersuchungen ([Online-]Evaluation) erfolgte nach 6, 12 und 24 Monaten durch Befragung der subjektiven Patientenzufriedenheit und Bestimmung des KOOS (Knee injury and Osteoarthritis Outcome Score).Insgesamt hatten 358 Patienten isolierte Defekte im Bereich des medialen Kondylus, 25 Patienten isolierte tibiale Defekte und bei den restlichen 49 Patienten lagen kombinierte Defekte (kissing lesions) vor. Unterschiede zwischen Männern und Frauen in Bezug auf die Defektpathologie gab es nicht, Patienten mit isolierten femoralen bzw. tibialen Defekten waren signifikant jünger als Patienten mit kombinierten Defekten. Tendenziell hatten Patienten mit einem tibialen Defekt eine kürzere Anamnesedauer. Als Therapie kam in 20,1% der Fälle die Knochenmarkstimulation, in 39,9% die autologe Knorpeltransplantation allein bzw. in 8,1% der Fälle die Knorpeltransplantation in Kombination mit einer Spongiosaplastik zur Anwendung. Sonstige Therapieverfahren waren Bohrung, osteochondrale Transplantationen, matrixassoziierte Mikrofrakturierung, Débridement. In 17,9% der Fälle erfolgten kombinierte Verfahren. Begleiteingriffe wurden bei 39,7% der Patienten mit einem isolierten femoralen, bei 56,0% der Patienten mit einem tibialen und in 67,6% bei kombinierten Defekten durchgeführt. Hierbei handelte es sich in den meisten Fällen um zusätzliche Tibiakopfosteotomien. Subjektiv waren Patienten mit einem femoralen Defekt signifikant häufiger sehr zufrieden/zufrieden, gefolgt von Patienten mit isoliertem Tibiadefekt. Am schlechtesten schlossen Patienten mit kombinierten Defekten ab. Der KOOS betrug zur Eingangsuntersuchung im Median 52 Punkte und stieg nach 6 Monaten auf 75, nach 12 Monaten auf 78 und nach 24 Monaten auf 80 Punkte an. Dabei zeigten Patienten mit einem isolierten femoralen Defekt tendenziell bessere Ergebnisse als die übrigen Patienten. Die Gesamtrevisionsrate betrug 7,1%.Die Daten zeigen, dass bei der Behandlung degenerativer Knorpelschäden des medialen Gelenkkompartiments des Kniegelenkes (Früharthrosen) durch knorpelregenerative Verfahren in solchen Fällen kurz- und mittelfristig akzeptable Ergebnisse erzielt werden können.