Biologische und biomechanische Grundlagen der arthroskopischen Rotatorenmanschettenrekonstruktion

Zusammenfassung: Eine erfolgreiche arthroskopische Rotatorenmanschettenrekonstruktion im Langzeitverlauf ist nicht nur von der rein technischen Wiederherstellung der Kontinuität des Muskel-Sehnen-Knochen-Komplexes, sondern auch von vielen weiteren Faktoren abhängig. Neben einer korrekten und schonenden Operationstechnik spielen u.a. biologische Faktoren wie die Muskel- und Sehnenqualität der Rotatorenmanschette sowie die Knochenqualität der Reinsertionszone für das Outcome eine wesentliche Rolle. In diesem Zusammenhang sind insbesondere die fettige Infiltration, Atrophie und Retraktion der rupturierten Rotatorenmanschette, die Sehnendegeneration sowie Osteopenie der Reinsertionszone an den Tuberkula zu berücksichtigen. Des Weiteren müssen grundlegende biomechanische Prinzipien bei der Nahttechnik und Fadenankerplatzierung beachtet werden, um ein technisch bedingtes Versagen der Refixation zu vermeide

Sandwich Technique for Large Osteochondral Lesions of the Knee

Objective To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. Design Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Results Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling. Conclusion MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery