[Abrasion arthroplasty].

Abstract

The removal of areas of chondromatous hyaline cartilage and the attempt to create new lod capacities for articular surfaces remain an encore in miscellaneous variations, pursued over decades in the last century. Recent research findings describe the biochemical interrelations and the three-dimensional structures of the collagenic matrix much more exactly. It was not until now a better insight into the metabolism and the dependent "state of aggregation" of the cartilage under changing mechanical exertion was made possible. From it prove, that the hyaline cartilage of the articulations represent a highly differentiated structure that is susceptible to mechanical and metabolic noxa and avails of remarkably minimal capability of regeneration. The results of repair are not within reach to approximate to functional ability of the original. This lights up that the amititious beginning to get to qualitative comparable regeneration by repair is not completed yet. Previous and furthermore differentiated and with restrictions of chondrocytes in compound with other protective and stimulating substances. Hitherto it seems advisable to refrain from steps being too active therapeutically. The unadulterated open abrasion of pathological articular cartilage has to be marked obsolete, today. Also the effect of abrasive arthroplasty, inductive character suggested, remains in the opinion of well-known authors in no proportion to expenditure of operation and rehabilitation and the expenses, because a sustaining success is not be expected in the long run, no matter whether drilling is done merely subcortical or subchondral, or use of spongiosa or microfracturing procedures. A more positive perspective in therapy appears with the holmium YAG-laser paving the way for gently treatment merely for degenerated cartilage: Regenerative beginnings to build hyaline cartilage have been reported. The abrasive arthroplasty probably will establish as a joint-conserving procedure in combination with the possibility of transplantation of chondrocyxtes to improve specific construction of the collagen matrix.