Stellenwert des Débridements bei der Behandlung fokaler (Grad II – III) Knorpelschäden des Kniegelenks. Systematische Literaturübersicht und Empfehlungen der AG Geweberegeneration (DGOU)

Gelse K, Angele P, Behrens P, Brucker PU, Fay J, Guenther D, Kreuz P, Luetzner J, Madry H, Mueller PE, Niemeyer P, Pagenstert G, Tischer T, Walther M, Zinser W, Spahn G (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Zeitschrift für Orthopädie und Unfallchirurgie Thieme

Book Volume: 156

Pages Range: 423-435

Journal Issue: 4

DOI: 10.1055/s-0044-101470

Abstract

In clinical practice, there is still no definite treatment algorithm for focal, partial thickness cartilage lesions (grade II - III). It is well-established that debridement (shaving/lavage) of large degenerative cartilage lesions is not recommended, but there is no such recommendation in the case of focal, partial thickness cartilage defects.The scientific rationale of cartilage shaving and joint lavage was investigated and a systematic analysis was performed of the literature on the clinical effect of cartilage debridement. Furthermore, a consensus statement on this issue was developed by the working group on Clinical Tissue Regeneration of the German Society of Orthopaedics and Trauma (DGOU).The therapeutic approach is different for asymptomatic lesions with biomechanical stable residual cartilage tissue and clinically symptomatic defects with unstable fragments. The benefit of a joint lavage or surface smoothening of focal partial thickness has not been proved. Even more importantly, the mechanical or thermal resection of cartilage tissue even induces a zone of necrosis in adjacent cartilage, and thus leads to additional injury. Therefore, large scale smoothening (shaving) of clinically asymptomatic, fibrillated or irregular cartilage defects should not be performed. However, if there are clinical symptoms, resection of unstable and delaminated cartilage fragments may be reasonable, as it can reduce harmful shear tension in residual tissue. This can help to brake the progression of the damage and avoid formation of free bodies.The decision criteria for debridement of partial thickness focal cartilage lesions are multifactorial and include the clinical symptoms, the size and the degree of the defect, the stability of remaining cartilage, localisation of the defect, and individual patient-specific parameters. Debridement is not recommended for asymptomatic lesions, but may be reasonable for symptomatic cases with unstable tissue.

Authors with CRIS profile

Kolja Gelse Unfallchirurgische Abteilung in der Chirurgischen Klinik

Involved external institutions

Universitätsklinikum Regensburg DE Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School DE Germany (DE) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) Ludwig-Maximilians-Universität (LMU) DE Germany (DE) OrthoPlus München DE Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE) St. Vinzenz-Hospital DE Germany (DE) Universitätsspital Basel CH Switzerland (CH) Asklepios Kliniken DE Germany (DE) Universitätsklinikum Freiburg DE Germany (DE) Universitätsmedizin Rostock DE Germany (DE) Klinikum Harlaching DE Germany (DE) Universitätsklinikum Jena DE Germany (DE)

How to cite

APA:

Gelse, K., Angele, P., Behrens, P., Brucker, P.U., Fay, J., Guenther, D.,... Spahn, G. (2018). Stellenwert des Débridements bei der Behandlung fokaler (Grad II – III) Knorpelschäden des Kniegelenks. Systematische Literaturübersicht und Empfehlungen der AG Geweberegeneration (DGOU). Zeitschrift für Orthopädie und Unfallchirurgie, 156(4), 423-435. https://doi.org/10.1055/s-0044-101470

MLA:

Gelse, Kolja, et al. "Stellenwert des Débridements bei der Behandlung fokaler (Grad II – III) Knorpelschäden des Kniegelenks. Systematische Literaturübersicht und Empfehlungen der AG Geweberegeneration (DGOU)." Zeitschrift für Orthopädie und Unfallchirurgie 156.4 (2018): 423-435.

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