Cartilage Repair: New Approaches

It’s only a short Moment is – its consequences affect the rest of the life. The Stumble üabout an obstacle or a Occurs when Fußball can prevent someone will remain mobile into old age. Because of resulting injuries, relate to häoften the cartilage that lines the joints and supple hält. In particular, the knee suffers when Stücke this sliding bearing reißen or splinters.

Cartilage is not vascularized, there are no fresh cells to grow. The existing are in a mesh of collagen and other Gerüstsubstanzen gewissermaßen walled in, so that they divide and multiply köcan. Therefore, besch&auml heals;digter cartilage is almost non-existent. He needs tutoring.

The fight against osteoarthritis

Doctors have long been searching for an effective method. Because the remains of the injury is left untreated, it can result in years or decades, später a osteoarthritis to develop. At the end of this Verschlei&szlig requires; häoften even the installation of a küartificial joint.

It is so far, have Äa lot of doctors already tried, such as grafts from other cartilage areas in the knee of the patient, or micro-holes in the joint, the stem should mobilisiernen cells from the bone marrow. The most advanced method, but developed in the early 1990s, a group of researchers from Sweden. The researchers took 23 patients with beschädigtem knee joint, a Stück cartilage and cultured the resulting cells für about three weeks in the laboratory. Anschließend they covered the cartilage defect with a Stück bone-in skin from the leg rail, and injected him with the gezüdespised cells.

Pioneers für more agility

The majority of patients benefited from this extensive procedure. The pain ließs, the mobility of the knee zur&uuml returned;ck. Tatsäthe take up of new cartilage formed &ndash had; new fabric from köbody’s own raw materials. It has the großen advantage that the Köbody it’s not abstößt and that it is the Original äsimilar as with other methods educated replacement.

The pioneers from GöGothenburg soon found imitators, scientists refined the technique in a lot of ways. The basic principle, however, remained the same: the cartilage is removed, its cells are from your Gerüst freed, and, increasingly, the Defect aufzufücases.

Move away from the bone to the skin

However, bone-in skin cover, for example, is hardly ever used today because they tend to growths in and around the treated area. "In the beginning we had to operate, therefore, around a third of the patients again, to beseitigen&quot this scar tissue;, Professor Matthias Steinwachs, surgical Orthopäde at the sports clinic reported

But as the cells are applied to the defective cartilage? A Ideallösung türesearchers fteln until today. Zunäfirst came a collagen membrane
in place of the periosteum. Collagen is also one of the basic substances of the natünatural cartilage. The benösaturated cells are gleichmäßig distributed.

Gerüste, the self-auflösen

Only a few years später was the näthe most method of cartilage formation developed: küartificial Gerüste, where the cells are oriented. One of the pioneers in this field, Professor Michael Sittinger, head of Tissue Engineering at the center f&uuml was;r Regenerative therapies in Berlin.

He sat on Polyglycolide – a Material that also für selbstauflösend Operationsfäthe is used. It lässt a fine non-woven manufacture in which the cartilage cells distribute. Wäduring this your natüfearful Gerüst form, builds the fleece.

Encouraging Results

In the process, cartilage is formed is apparently stable, as a study of 21 patients zwölf years after the procedure. "This three-dimensional Zellgerüst is a progress, because it zuverlämore than the bloße cover of the Defekts", Sittinger says. Meanwhile, a Freiburg-based company marketed his discovery.

Other providers use a Gerüst of collagen, which breaks down in the course of time. "The große advantage is that The cartilage cells are gleichmäßig spread and find a suitable environment vor", Professor Joachim Grifka, Director of the Orthop&auml says;Jewish hospital the Universität Regensburg, in Bad Abbach. Expert stone wax ergänzt: "Compared with the Original, you will reach a Knorpelqualität from 70 to 90 percent."

In every sphere of 200,000 cells stuck

Another way a company goes from the Brandenburg Teltow. Not vödue to a Gerüst and the cells are propagated so that these small Küglobule is less than a Millimeter in diameter. Each Küglobule enthält about 200,000 cells. In the defective joint is introduced, the balls quickly and build your natünatural Stützsubstanzen on.

Cartilage repair procedures by means of a Ball

Cartilage removal
A doctor takes the case of a joint reflection, two cartilage cylinders from a low-loaded Region. (In Detail, the methods differ. Here is an example of good practice)

Separation of the cartilage cells
In the laboratory, the cartilage is mechanically crushed and in a Enzymlösung bathed, to individual cells.

Proliferation of the cells
Für three to four weeks, the cartilage cells multiply at about 37 degrees.

To grow together to Küglobule
The cells are &uuml in a kind of laboratory-eggshell;transferred. There, they connect to Mini-Küglobule.

Auffücases of the defect
The doctor überträthe K&uuml gt;globule into the joint. There you will connect and develop to naturähnlichem cartilage.

Advantage of this method: Both the tissue sampling, as well as the K&uuml Bring;globule does not require open surgery, but only a Knee arthroscopy. The procedure received künewly the approval für the whole of Europe – so far the only in Germany.

Für arthritis is not suitable

The Küglobule and other substances in the Knorpelzüaution are not classified as a medical product but as a medicinal product. The große advantage für the patient: The procedure müshot in the course of extensive scientific studies show that your Benefits möpossible risks überwiegt. Previously, you cut it consistently better than comparison therapies.

The choice between Kollagengerüst and Küglobule does not hold many experts für the only decisive factor. You gehört Professor Philipp Niemeyer, the first author of a position paper of the society für Orthopäthe and accident surgery for cartilage healing. "At least as important is the Knorpelsch&auml is that existing causes are treated;the begünstigen", the expert f&uuml says;r knee joint and cartilage surgery, OCM-clinic in MüMunich. Leg deformities, for example, or an unstable joint.

Einschrälimitations of the repair methods

Because the opportunity of a cure provides the cell replenishment, at best, für very
frühe stages of the Gelenkverschleißit will only affect a local area.
The majority of the many people who are already suffering from osteoarthritis or rheumatism
suffer, not benefit from the innovative procedure.

Also, the authors of the position paper recommend that the Cartilage from the laboratory, only three to four square inches großen defects in young and active patients of 2.5 square centimetres. The success rate üNiemeyer convinced: Just about 20 percent of the Treated benöclear within ten to 15 years, a new intervention.

2019 will be a rating of the methods

Until the end of 2019 üaccept the health insurance the cost of the cell therapy. Then a re-evaluation by the Joint Federal Committee of the funds, Ädoctors and Krankenhäuser planned. The chances are according to experts, a good, that treatment will continue to be paid. However, müshot patients, applying in any case, a lot of patience.
At least a year it takes to go skiing again or Fußball k&ouml play;can.