Zusammenfassung
Aufgrund der Bedeutung der Menisken zur Arthroseverhinderung sollte bei jungen Patienten mit Meniskusläsion, die nicht refixiert oder sparsam reseziert werden können, eine Meniskustransplantation in Betracht gezogen werden. Bandstabilität und gerade Beinachsen sind dabei eine Voraussetzung. Das Vorliegen von fortgeschrittenen Knorpelveränderungen ist eine Kontraindikation. Die allogenen Meniskustransplantate entsprechen am ehesten den biomechanischen Anforderungen des originären Meniskus. Zumeist wird tiefgefrorenes Material verwendet. Das Risiko der Krankheitsübertragung muss als Komplikationsmöglichkeit genannt werden. Für die Meniskustransplantation werden offene und arthroskopisch assistierte Operationstechniken beschrieben. Wichtig für das Ergebnis der Meniskustransplantation sind die korrekte Größenbestimmung und Positionierung des Transplantatmeniskus sowie die sichere Fixierung am Vorder- und Hinterhorn. Publizierte Nachuntersuchungen zeigen, dass eine Schmerzreduktion und Funktionsverbesserung möglich sind. Größer angelegte Langzeitstudien, die beweisen, dass durch Meniskustransplantation die Entwicklung einer Arthrose verhindert werden kann, stehen noch aus.
Abstract
Loss of meniscal cartilage leads to degenerative arthritis. Therefore, it is important to save the meniscus whenever possible. But not all damaged menisci can be treated by partial resection or repair. The concept of meniscal transplantation has been suggested and has been become more common in recent years. Meniscal transplantation should be considered for the young patient who has not developed advanced osteoarthritis. Ligament stability and normal knee alignment are further requirements for meniscal transplantation. At this time, meniscal allografts provide the best a priori conditions to prevent degenerative arthritis, but the use of allografts includes the risk of disease transmission. Open and arthroscopically assisted techniques have been described. Correct size matching and positioning as well as secure fixation of the meniscal horn are important for successful meniscal allograft transplantation. Even though controlled clinical studies have not yet provided clear evidence that meniscal transplantation prevents degenerative arthritis, pain relief and functional improvement have been found in follow-up studies.
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Lewinski, G. Allogene Meniskustransplantation. Orthopäde 37, 743–748 (2008). https://doi.org/10.1007/s00132-008-1268-7
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DOI: https://doi.org/10.1007/s00132-008-1268-7