U. Guhlke-Steinwachs

University of Freiburg, Freiburg, Baden-Württemberg, Germany

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Publications (5)2.55 Total impact

  • Source
    M R Steinwachs, P C Kreuz, U Guhlke-Steinwachs, P Niemeyer
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    ABSTRACT: Joint cartilage damage in adults has practically no tendency to self healing. Symptomatic grade III/IV damage requires surgical treatment. There are special challenges involved in cartilage damage in the patellofemoral joint as the complicated biomechanics of the joint is often combined with dysplasia. All tissue regeneration measures are based on the recruitment of cells. The synovial cells available in the joint can be differentiated to fibrous cartilage under certain mechanical conditions; however, they cannot sufficiently fill in defects. Also the use of bone marrow cells for cartilage reconstruction only creates mechanically inferior fibrous cartilage (Pridie drillings, microfracture, AMIC). Presently only cultivated, autologous chondrocytes from the lab are available for a biomechanically high-quality reconstruction of the cartilage layer.The application of mesenchymal stem cells is a subject of extensive international research. However, the first experimental studies, after initial formation of cartilage, disappointingly show significant ossification. Essential conditions for a successful treatment of patellofemoral cartilage damage are the diagnosis of accompanying pathological conditions, selection of the right cartilage-regenerating procedure, sufficient removal of the basic pathological defect, and implementation of standardized rehabilitation.
    Der Orthopäde 09/2008; 37(9):841-7. · 0.67 Impact Factor
  • Source
    M.R. Steinwachs, P.C. Kreuz, U. Guhlke-Steinwachs, P. Niemeyer
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    ABSTRACT: Gelenkknorpelschäden des Erwachsenen haben praktisch keine Selbstheilungstendenz. Dies macht bei symptomatischen Grad-III/IV-Schäden eine operative Therapie erforderlich. Eine besondere Herausforderung sind dabei Knorpelschäden im patellofemoralen Gelenk, da hier eine komplexe Biomechanik des Gelenks häufig mit Fehlanlagen kombiniert ist. Alle Maßnahmen der Geweberegeneration basieren auf der Rekrutierung von Zellen. Die im Gelenk vorhandenen Synovialzellen lassen sich unter bestimmten mechanischen Bedingungen zu Faserknorpel differenzieren, können aber Defekte nicht suffizient auffüllen. Auch die Verwendung von Knochenmarkzellen zur Knorpelrekonstruktion lässt bisher nur einen mechanisch minderwertigen Faserknorpel (Pridie-Bohrungen, Microfracture, AMIC®) entstehen. Für eine biomechanisch hochwertige Rekonstruktion der Knorpelschicht stehen gegenwärtig nur vermehrte autologe Chondrozyten aus dem Labor zur Verfügung. Der Einsatz von mesenchymalen Stammzellen ist Gegenstand großer internationaler Forschungsanstrengungen. Erste experimentelle Studien zeigen aber nach einer initialen Knorpelbildung eine signifikante Verknöcherung des Knorpels und damit bisher ein enttäuschendes Resultat. Wesentliche Voraussetzungen für eine erfolgreiche Behandlung von patellofemoralen Knorpelschäden sind die Diagnose von Begleitpathologien, die Auswahl des richtigen knorpelregenerativen Verfahrens, die suffiziente Beseitigung der Grundpathologie und die Anwendung einer standardisierten Rehabilitation. Joint cartilage damage in adults has practically no tendency to self healing. Symptomatic grade III/IV damage requires surgical treatment. There are special challenges involved in cartilage damage in the patellofemoral joint as the complicated biomechanics of the joint is often combined with dysplasia. All tissue regeneration measures are based on the recruitment of cells. The synovial cells available in the joint can be differentiated to fibrous cartilage under certain mechanical conditions; however, they cannot sufficiently fill in defects. Also the use of bone marrow cells for cartilage reconstruction only creates mechanically inferior fibrous cartilage (Pridie drillings, microfracture, AMIC®). Presently only cultivated, autologous chondrocytes from the lab are available for a biomechanically high-quality reconstruction of the cartilage layer. The application of mesenchymal stem cells is a subject of extensive international research. However, the first experimental studies, after initial formation of cartilage, disappointingly show significant ossification. Essential conditions for a successful treatment of patellofemoral cartilage damage are the diagnosis of accompanying pathological conditions, selection of the right cartilage-regenerating procedure, sufficient removal of the basic pathological defect, and implementation of standardized rehabilitation.
    Der Orthopäde 09/2008; 37(9):841-847. DOI:10.1007/s00132-008-1290-9 · 0.67 Impact Factor
  • Medizinische Monatsschrift für Pharmazeuten 05/2003; 26(4):123-9.
  • M R Steinwachs, C Erggelet, A Lahm, U Guhlke-Steinwachs
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    ABSTRACT: The treatment of deep cartilage defects is a challenge for every orthopaedic surgeon. The potential for regeneration of cartilage tissue is minimal and leads to mechanically inferior fibrous tissue. The established techniques induce the growth of fibrous tissue but fail to prevent arthrosis. Autologous chondrocyte transplantation seems to be the most promising therapy concept with clinical relevance to reserves a full thickness cartilage defect with hyaline-like cartilage. Outcome studies with a follow up from 2-10 years show in up to 90 % good and excellent results for defects on the femoral condyle and 70 % for the patella. Mechanical testing of the regenerated cartilage showed almost similar stiffness as nearly normal hyaline cartilage. The available data justify the acceptance of autologous chondrocyte transplantation as a standard procedure for limited indications and well-trained surgeons. Result of already inaugurated studies will show the potential of chondrocyte transplantation to prevent osteoarthritis.
    Der Unfallchirurg 12/1999; 102(11):855-60. · 0.61 Impact Factor
  • M. R. Steinwachs, C. Erggelet, A. Lahm, U. Guhlke-Steinwachs
    [Show abstract] [Hide abstract]
    ABSTRACT: The treatment of deep cartilage defects is a challenge for every orthopeadic surgeon. The potention for regeneration of cartilage tissue is minimal and leads to mechanically inferior fibrous tissue. The established techniques induce the growth of fibrous tissue but fail to prevent arthrosis. Autologous chondrocyte transplantation seems to be the most promising therapy concept with clinical relevance to reserves a full thickness cartilage defekt with hyaline-like cartilage. Outcome studies with a follow up from 2-10 years show in up to 90% good and excellent results for defects on the femoral condyle and 70% for the patella. Mechanical testing of the regenerated cartilage showed almost simular stiffness as nearly normal hyaline cartilage. The available data justify the acceptance of autologous chondrocyte transplantation as a standard procedure for limited indications and well-trained surgeons. Result of already inaugurated studies will show the potential of chondrocyte transplantation to prevent osteoarthritis.
    Der Unfallchirurg 09/1999; 102(11):855-860. DOI:10.1007/s001130050494 · 0.61 Impact Factor

Publication Stats

41 Citations
2.55 Total Impact Points

Institutions

  • 1999–2003
    • University of Freiburg
      • Department of Orthopedics and Traumatology
      Freiburg, Baden-Württemberg, Germany