Lebensqualität und Gelenkfunktion nach Knorpel-Knochen-Transplantation

Abstract

The aim of the study was to evaluate the clinical benefit of the autologous osteochondral transplantation according to quality of life and joint function at a mean Follow-Up of 7 years. We hypothesized that the osteochondral autografting presents a significant improvement in (1) quality of life, (2) joint function and (3) cartilage structure (p<0.05). Moreover, the influence of age, BMI, defect size as well as the time between suffering trauma and surgery was measured. Thirty-one of thirty-eight patients were examined (21 men, 10 women). The average age was 35 years (17-53 years), the middle BMI was 25 kg/m² (19-32 kg/m²). The average period between trauma and surgery was 53 days (7-140 days). Monofocal osteochondral lesions III° (n=11) or IV° (n=20) were treated (Outerbridge classification). The average defect size was 3 cm2 (1-4.8 cm2). For transplantation the Smith & Nephew MOSAICPLASTY® system was used. All surgeries were executed by one surgeon. The mean Follow-Up was 7 years (4.4-9.3 years). For evaluation the ICRS-Evaluation-Package was used. Data analysis was performed by SPSS, Volume 13. We observed a pain reduction, improvement of the subjective health feeling as well as an improvement of the vitality feeling (reduction of the somatic discomfort). Significant differences of the SF-36-Values ( physical pain (p <0.001), general health perception (p <0.001), vitality (p=0.008) and physical sum scale (p <0.001) were noticed. In comparison to the standard values of the German population nearly normal values were reached. There was a significant correlation between the SF-36-Values and the BMI ( physical effectiveness (p=0.013) as well as the emotional role function (p=0.01)). With increasing BMI the values of the physical functioning and the values of the emotional role function (p=0.01) decreased. The defect size has a significant influence on the change of the psychic health feeling . As bigger the defect size was as worse was the psychic health feeling (p=0.036). The general state of health was improved. The IKDC-Values showed a significant improvement in 26 cases (p<0.001). BMI and IKDC-Values showed a linear correlation. With increasing BMI the IKDC-Values decreases (p=0.025). As bigger the BMI is as more slightly is the improvement of the scale values. Only the patients with a BMI lower than 25 kg/m² showed positive scale values. Defect size, the time between suffering the trauma and the surgery as well as the age showed no significant correlation according to the IKDC-Values. The ICRS-Score (MRI) was improved in 26 of 28 cases (n=12: normal, n=14: almost normal). The autologous osteochondral transplantation is an established method to treat articular cartilage defects in stage III or IV. This study shows a better quality of life, joint function and cartilage structure after autologous osteochondral transplantation of the knee. Patient selections with respect to the individual resources (compliance, BMI) as well as the correct indication (defect size, age) are determining factors in order to get good clinical results. As higher the BMI or the defect size is, as worse are the clinical results. The time interval between suffering the trauma and the surgery seems to have no influence on the results. Nevertheless, studies with bigger patient groups and the use of standardized scores (ICRS- Cartilage Repair Evaluation Package) are needed to get a valid and comparable statement.