For 30 years several regenerative cartilage treatment procedures are in clinical use in Germany. Not all of them are available in other countries inside and outside Europe.
According to guidelines from the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU) the selection of a distinct regenerative cartilage treatment procedure is dependent on cartilage defect size, the involvement of the subchondral plate and the underlying subchondral bone. Of course, further patient-specific parameters, like BMI, sport / work activities and patient expectations will further help to choose the most suitable regenerative cartilage treatment procedure for an individual patient. Also the necessity of treating the comorbidities (Leg axis deviation, instability, meniscus tear) has to be included in the treatment plan of the patients.
Microfracture is still the most frequently used technique for cartilage repair, also in Germany. In order to be successful with microfracture, one should use it only in small defects (<2cm2) or combine it with cell free biomaterials.
The indication of Osteochondral transplantation (OCT) has narrowed over the years. It is indicated for small, mainly osteochondral defects, which allow sufficient treatment with one or two osteochondral plugs. For larger defects, the donor-side morbidity is of concern.
Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. This technique is available and widely used in Germany. Due to regulatory burdens in terms of harvest and culture of chondrocytes, the organizational effort of this technique is high. Therefore, this technique is mainly performed in center with specialization to cartilage treatment. In Germany, 3 different chondrocyte-based transplantation techniques are available (Novocart 3D (Aesculap, TETEC), Novocart inject (Aesculap, TETEC), Spherox (Codon). According to the German cartilage registry, which include over 10.000 patients, treated with regenerative cartilage procedures, the outcome of the 3 techniques is significant but comparable with each other. Based on best available scientific evidence, an indication for ACI is given for symptomatic cartilage defects, not only for traumatic but also for early-OA cartilage defects, starting from defect sizes of more than 2 cm2, while advanced degenerative joint disease needs to be considered as the most important contraindication.
Due to the limited access to osteochondral allografts, special sandwich techniques were developed in Germany to address bone and cartilage defects in huge osteochondral defects. The talk will describe recent developed techniques and show outcome results.
Unfortunately, recent advances in stem cell technology could not be translated in the clinic due to regulatory burdens in Germany. The use of these techniques in clinical trials would be of interest.
A newly developed cartilage repair procedure, minced cartilage technique, is used in Germany. The advantage is an one-step cartilage repair procedure without the regulatory burdens of the ACI technique. First results are promising, however, prospective outcome results are not available.
The rehabilitation after regenerative cartilage repair procedures is long. After ACI a return to sport is possible approximately after 1 year. Return to sport tests are used in Germany in order to analyze the neuromuscular ability for pivoting sports after 1year. The talk will show the need for these return to sport tests to avoid further reinjuries after rehabilitation.