CARTILAGE


KnorpelverschleissInjuries and signs of wear of the knee cartilage are one of the most common diseases in orthopedics. One distinguishes the local limited cartilage damage from the general cartilage wear, the so-called osteoarthritis. Typical symptoms of cartilage damage in the knee are stress-related pain and swelling.

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The treatment options are varied and depend on the causes and severity of the cartilage damage. Therefore, we attach great importance to accurately analyze the pain of the affected person, so that we can take into account the causative factors. The most important success factor of the cartilage damage treatment is to provide the patient with the right therapy at the right time and, in addition to the damage to the cartilage, above all to remedy its cause. The size, the localization and the extent in the depth (participation of the bone) play a decisive role. In addition, we take into account the patient's needs and age and insist that probable ligament instabilities or axial malalignments, which can cause cartilage damage, are necessarily treated simultaneously. In some cases, this can lead to combination surgery from cartilage therapy and ligament reconstruction or axis correction.

Conservative therapy


The therapy of cartilage damage depends not only on the stage, but also on the needs of our patients and their lifestyle. Conservative therapy therefore aims to reduce the factors that can be influenced externally as much as possible. Since the pain is due to local inflammation, it can be reduced by anti-inflammatory drugs as well as concomitant symptoms.

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The drugs of first choice are medications with strong pain and swelling relief, the so-called non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs. Also dietary supplements such as the combination of glucosaminoglycan and chondroitin sulfate have been shown to have a positive influence on knee osteoarthritis. Freedom from pain is a prerequisite for improving the muscular situation with targeted physiotherapy. Strengthening of the musculature, mobilization of the joints as well as the improvement of the coordination are in the foreground. Supportive physical measures can be applied with heat or cold applications, electrotherapy or ultrasound. The acupuncture treatment has been shown to reduce pain as well. In addition, we use orthopedic devices such as special tape systems, bandages, splints and orthopedic buffer heels to treat osteoarthritis and instability.

Cell Therapy


While common practice is the use of hyaluronic acid in the mixture with cortisone, at the Knee and Hip Institute we rely more on cell therapy, where we inject the cartilage with highly concentrated, body-own growth factors, the so-called ACP (autologous conditioned plasma) from the body's own blood can handle successfully. The body's own regenerative powers of the growth factors in the blood (from the platelets or platelets) stimulate healing and development processes in the damaged articular cartilage. Because this therapy is based on the body's own mechanisms, side effects are virtually eliminated.

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You can find further information on cell-based therapies here.

Minimally invasive therapy


In the case of extensive cartilage damage but with residual cartilage still present, we use the so-called microfracturing, by which the stem cell production is stimulated. Here, the bone is opened arthroscopically minimal, so that bone marrow cells and stem cells can accumulate in the cartilage defect.








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Thus, a fibrous surrogate cartilage (fibrocartilage) may arise which, while not having the mechanical properties of the original cartilage, can result in significant pain relief. Again, we strongly recommend the support of a cell therapy, most likely by ACP; as this demonstrated masses in the joint causes no inflammation and thus produces a safe healing.

Transplanting cultured cartilage - MACI


For more than ten years, the transplantation of autologous cultured cartilage (ACT) has been successfully used to replace and repair missing or injured cartilage - especially in traumatic and superficial defects without involvement of the bone. The indication for the ACT must therefore be considered very carefully and has its limits, which we discuss with you in individual cases.

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For autologous chondrocyte transplantation, two procedures are always necessary: In the first, we collect a minimal amount of cartilage cells from arthroscopy during an arthroscopy, which is then propagated in a certified laboratory. When the necessary number of cells is reached after about 3-6 weeks, we reimplant the cartilage cells into the defect zone in the second procedure. This can even be done arthroscopically depending on the size of the defect. Should misalignments be responsible for the cartilage damage, they should be treated as a matter of course.