Platelet-rich plasma (PRP) as therapy for cartilage, tendon and muscle damage - German working group position statement.

PURPOSE: Platelet rich plasma (PRP) is widely used in orthopaedics, but is still heavily debated. Therefore, a survey among the German "Working Group for Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology was conducted to achieve a consensus about the current therapeutical potential of PRP. METHODS: A first survey (n = 65 experts, all orthopaedic/trauma surgeons) was conducted (n = 13 questions). Following, a second round (n = 40 experts) was conducted with 31 questions to achieve consensus in 5 categories: three most common indications, PRP application, future research areas. RESULTS: Therapeutic PRP application was regarded as useful (89%), possibly even more important in the future (90%). Most common indications were tendon pathologies (77%), osteoarthritis (OA) (68%), muscle injuries (57%) and cartilage damage (51%). Consensus was reached in 16/31 statements. The application of PRP for early knee OA (Kellgren-Lawrence grade II) was regarded as potentially useful, as well as for acute and chronic tendinopathies. For chronic lesions (cartilage, tendons), multiple injections (2-4) were seen preferable to singular injections. However, no sufficient data exists on the time interval between the injections. Standardization of PRP preparation, application, frequency, as well as determining the range of indication is strongly recommended. CONCLUSIONS: There is a need of further standardization of the PRP preparation methods, indication and application protocols for knee OA and other indications, which must be further evaluated in basic science studies and randomized controlled clinical trials. LEVEL OF EVIDENCE: Consensus of expert opinion, Level V.

Efficacy of quadruple treatment on different types of pre-operative anaemia: secondary analysis of a randomised controlled trial.

In patients with pre-operative anaemia undergoing cardiac surgery, combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12 and oral folic acid reduces allogeneic blood product transfusions. It is unclear if certain types of anaemia particularly benefit from this treatment. We performed a post-hoc analysis of anaemic patients from a randomised trial on the 'Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery'. We used linear regression analyses to examine the efficacy of a combination anaemia treatment compared with placebo on the following deficiencies, each representing a part of the combination treatment: ferritin and transferrin saturation; endogenous erythropoietin; holotranscobalamine; and folic acid in erythrocytes. Efficacy was defined as change in reticulocyte count from baseline to the first, third and fifth postoperative days and represented erythropoietic activity in the immediate peri-operative recovery phase. In all 253 anaemic patients, iron deficiency was the most common cause of anaemia. Treatment significantly increased reticulocyte count in all regression analyses on postoperative days 1, 3 and 5 (all p < 0.001). Baseline ferritin and endogenous erythropoietin were negatively associated with change in reticulocyte count on postoperative day 5, with an unstandardised regression coefficient B of -0.08 (95%CI -0.14 to -0.02) and -0.14 (95%CI -0.23 to -0.06), respectively. Quadruple anaemia treatment was effective regardless of the cause of anaemia and its effect manifested early in the peri-operative recovery phase. The more pronounced a deficiency was, the stronger the subsequent boost to erythropoiesis may have been.

[Back pain : State of the art and guidelines]. / Rückenschmerz : Aktuelle Entwicklungen und Leitlinien.

Pain in general and back pain in particular are associated with a variety of pathological, clinical, and sociocultural factors. There are numerous clinical and therapeutic treatment as well as imaging-options available and comprehensive knowledge is required to meet the individual clinical needs of those affected. This requires a high degree of interdisciplinary cooperation. In addition, back pain is covered differently by various numbers of insurance companies. Imaging methods, including the example of periradicular image-assisted interventions, are presented with regard to their indication and efficiency. The existing guidelines and evaluation recommendations with different structural and targeted approaches are discussed in addition to extensive legal aspects in the literature. In addition, the structured reports and the certificated curricula of the AG Bildgebende Verfahren des Bewegungsapparates (Working Group "Imaging Procedures of the Musculoskeletal System") of the Deutsche Röntgengesellschaft ("German Society of Radiology") are recommended for the quality assurance.

[Osteoarthritis classifications : Modification proposal for the criteria of Kellgren and Vallotton]. / Arthrose-Klassifikationen : Modifizierungsvorschlag für die Kriterien nach Kellgren und Vallotton.

BACKGROUND: In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50 years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. AIM: In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. METHODS: The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X­ray and MRI findings are compared. RESULTS: Suggestions for both a modification of the Kellgren classification as far as the criteria are concerned and a hierarchy (ranking) of X­ray and MRI findings to make clinical decisions more valuable are proposed. CONCLUSION: These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).

Degenerative isolated cartilage defects of the patellofemoral joint are associated with more severe symptoms compared to trauma-related defects: results of the German Cartilage Registry (KnorpelRegister DGOU).

PURPOSE: The purpose of this study was to utilize data from the German Cartilage Registry (KnorpelRegister DGOU) to examine the hypothesis that degenerative cartilage defects of the patellofemoral joint are associated with more severe clinical symptoms compared to trauma-related defects. METHODS: All patients with isolated focal cartilage defects of the patellofemoral joint registered in the German Cartilage Registry until May 2017 were included in the study. Patients with previous surgery of the ipsilateral knee were excluded. Baseline data including etiology (traumatic, degenerative), size, location and ICRS grade of the cartilage defects as well as the duration of symptoms were analyzed. Clinical symptoms were evaluated by means of the numeric analog scale (NAS) for pain and the Knee injury and Osteoarthritis Outcome Score (KOOS). Group comparisons were performed using the Mann-Whitney-U test along with the Chi-squared test and Fisher's exact test. A bivariate correlation analysis and a multivariable linear regression analysis were performed to investigate the association between the defect characteristics and the clinical scores. RESULTS: A total of 423 patients (203 traumatic and 220 degenerative defects) were included. Isolated degenerative cartilage defects were found to have significantly more trochlear locations (28% vs. 18%; p = 0.006), significantly less ICRS grade 4 lesions (50% vs. 73%; p = 0.002) and a significantly smaller defect size [median 300 (IQR 105-400) vs. 300 (200-400) mm2] when compared to those from traumatic etiology. Traumatic defects showed significantly better KOOS-ADL [77 (60-90) vs. 69 (56-82); p = 0.005], KOOS-pain [69 (56-81) vs. 61 (47-75); p = 0.001] and NAS [2 (1-5) vs. 4 (1-6); p = 0.005] scores compared to degenerative defects. The correlation analysis revealed only weak correlations between the quantitative defect characteristics and clinical scores. CONCLUSIONS: Degenerative isolated cartilage defects in the patellofemoral joint are associated with more severe clinical symptoms in comparison to trauma-related defects. Additionally, they show a larger variance regarding their location with more trochlear defects. LEVEL OF EVIDENCE: III.

[Treatment of Osteochondral Lesions in the Ankle: A Guideline from the Group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU)]. / Behandlung osteochondraler Läsionen des Sprunggelenks: Empfehlungen der Arbeitsgemeinschaft Klinische Geweberegeneration der DGOU.

Background: Osteochondral lesions (OCL) of the ankle are a common cause of ankle pain. Although the precise pathophysiology has not been fully elucidated, it can be assumed that a variety of factors are responsible, mainly including traumatic events such as ankle sprains. Advances in arthroscopy and imaging techniques, in particular magnetic resonance imaging (MRI), have improved the possibilities for the diagnosis of OCLs of the ankle. Moreover, these technologies aim at developing new classification systems and modern treatment strategies. Material and Methods: This article is a review of the literature. Recommendations of the group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU) for the treatment of OCLs of the ankle are presented. The review gives a concise overview on the results of clinical studies and discusses advantages and disadvantages of different treatment strategies. Results: Non-operative treatment shows good results for selected indications in children and adolescents, especially in early stages of osteochondritis dissecans (OCD). However, surgical treatment is usually indicated in OCLs in adolescents and adults, depending on the size and location of the lesion. Various arthroscopic and open procedures are frequently employed, including reattachment of the fragment, local debridement of the lesion with fragment removal and curettage of the lesion, bone marrow-stimulation by microfracture or microdrilling (antegrade or retrograde), and autologous matrix-induced chondrogenesis (AMIC®) - with or without reconstruction of a subchondral bone defect or cyst by autologous cancellous bone grafting. Isolated subchondral cysts with an intact cartilage surface can be treated by retrograde drilling and possibly additional retrograde bone grafting. For larger defects or as salvage procedure, osteochondral cylinder transplantation (OATS® or Mosaicplasty®) or matrix-induced autologous chondrocyte transplantation (MACT) are recommended. Transplantation of so-called (osteochondral) mega grafts, such as autologous bone grafts or allografts, are used for very large osteochondral defects that cannot be reconstructed otherwise. Implantation of the so-called "small metal implants" - such as HemiCAP Talus® - is reserved for selected cases after failed primary reconstruction. Corrective osteotomies are indicated in accompanying axial malalignments. Conclusions: There are several different treatment strategies for OCLs, but clinical studies are rare and evidence is limited. Therefore, interventional studies, e.g. randomised controlled trials (RCTs), but also observational studies, e.g. based on data of the Cartilage Registry of the German Society of Orthopaedics and Traumatology (www.knorpelregister-dgou.de), are needed and are recommended by the authors.

[Prognostic assessment in private healthcare insurance part 2 : Risk supplement for accidental endoprostheses]. / Prognosebeurteilung in der Privaten Unfallversicherung Teil 2 : "Risikozuschlag" bei unfallbedingten Endoprothesen.

After examining the causes of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed between the parties involved. In addition, this must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability. In contrast to scientifically based findings serving as a prognosis of osteoarthritis, in the case of endoprostheses forecasts can only be based on medical experience, which in this case has to satisfy the standard of proof of a high level of probability, since necessary replacement operations after insertion of a prosthesis are sufficiently probable. The prosthesis supplements that have been applied to date in the context of an assessment of prognosis have their justification. In applying them, however, it must be considered on one hand that this supplement is comprised of an equally weighted proportion for future risk and on the other hand a preventive portion. This increases in significance with different prostheses on one and the same limb.

[Prognostic assessment in private healthcare insurance part 1 : Risk of osteoarthritis]. / Prognosebeurteilung in der Privaten Unfallversicherung Teil 1 : Arthroserisiko.

After examining the cause of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed upon between the parties involved. In addition, this person must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability.The sole risk of the evolution of the functional deficit arising from a proven or prognosticated post-traumatic osteoarthritis is excluded from this standard of proof which means that flat-rate risk supplements are not suited to this individualized approach and thus do not apply.

[Bone Marrow Lesion - Risk-Factors and Pathophysiological Relevance: Systematic Review]. / Bone Marrow Lesion - Risikofaktoren und pathophysiologische Bedeutung: systematisches Review.

AIM: The objective of this systematic review and meta-analysis is to obtain information about risks and associated factors for knee symptoms and the progression of osteoarthritis in idiopathic bone marrow lesion (BML). MATERIALS AND METHODS: The primary search on 31. 12. 2013 included the databases PubMed, EMBASE, Web of Science and Cochrane by the search strategy [[bone marrow edema] AND [knee]]. This review was continuously updated up to 31. 10. 2015. RESULTS: A total of 30 studies (from 1331 primary findings) were included in the final evaluation. The mean frequency of BML in all studies was 37.2 %. The occurrence of BML was strongly dependent on the MRI technique used (1.0 to 3.0 T). In longitudinal studies, the incidence of BML was 3.2 (95 % CI 1.7-6.3)/1000 person-months. Weakly associated factors included female gender (OR = 1.3 [95 % CI 1.1-1.7], p = 0.009), increasing age (OR = 1.05 [95 % CI 0.9-1.3], p = 0.127), and overweight or obesity (OR = 1.1 [95 % CI 1.1-1.2]; p < 0.01). BMLs are significantly associated with cartilage lesions (OR = 5.5 [95 % CI 1.3-22.5]). Radiological osteoarthritis is also significantly associated with the development of BML (OR = 3.6 [95 % CI 1.2-10.6]) and the progression of osteoarthritis within a 3-year interval (OR = 4.4 [95 % CI 3.1-6.4]). CONCLUSIONS: The occurrence of BML is an important index for severe degenerative pathologies in the knee. It appears that MRT symptoms predict the progression of the disease. The clinical relevance and possible consequences for treatment are unclear.

[Magnetic Resonance Imaging, Arthroscopy and Near-Infrared Spectroscopy (NIRS) for Grading Osteoarthritis in the Knee]. / Methodenvergleich von Kernspintomografie, Arthroskopie und Nah-Infrarot-Spektroskopie (NIRS) bei der Bestimmung des Arthrosegrads des Kniegelenks.

PURPOSE: This study was aimed to evaluate the meaningfulness of the MRI Score WORMS (Whole Organ Magnetic Resonance Imaging), the arthroscopic WOAKS (Whole Organ Arthroscopic Knee Score) and the result of NIRS (near-infrared spectroscopy) measurements. MATERIALS AND METHODS: A total of 49 patients with knee pain (> 3 months) underwent MRI with a standardised protocol. In the results the WORMS was calculated. The WOAKS was calculated from the results of an arthroscopic evaluation. In the same procedure, NIRS measurements were performed in the identical 14 regions of interest. From these measurements, the WOAKS_NIRS was calculated. RESULTS: The highest grade of degeneration in all evaluations was found in the patella. The medial compartment showed moderate lesions compared with the lateral compartment. The relative WORMS was only 3.7 % (95 % CI 2.8-4.6; 0-15.6 %). During arthroscopy, we calculated a mean WOAKS of 15.2 % (95 % CI 13.2-17.2; 5-39 %). The degree of joint degeneration was highest in NIRS measurements. The mean WOAKS_NIRS was 50.9 % (95 % CI 48.1-53.7 %). These differences are significant (p < 0.001). CONCLUSION: The methods to detect early cartilage degenerations in MRI are flawed. Thus in our patients, we detected a full grade of degeneration in only 3.7 % of the patients. Arthroscopy mostly gives higher damage within the knee joint. The initial stages of cartilage lesion are usually undetectable. Spectroscopy has the best sensitivity for the evaluation of early degeneration within the hyaline cartilage. The clinical relevance of our results is still unclear. Further outcome studies are needed.

[The time-related risk for knee osteoarthritis after ACL injury. Results from a systematic review]. / Das zeitabhängige Arthroserisiko nach vorderer Kreuzbandverletzung. Ergebnisse einer systematischen Literaturrecherche.

AIM: The aim of this review was to evaluate the time-related risk for knee osteoarthritis in patients after ACL injury. MATERIALS AND METHODS: The primary search was carried out in different medical databases with the deadline 12.01.2014. The search strategy for the evaluation was [ACL] AND [osteoarthritis] including "all fields". All 1656 title/abstracts were reviewed by two independent researchers who selected 140 papers for full text review. Finally, a total of 21 relevant publications were identified for inclusion in this current paper. RESULTS: The incidence of knee osteoarthritis rises significantly over time. Two years after injury it was 6.9%, after 5 years 32.2%, after 7 years 36.3%, and after 10 years 79.6%. At the same time, the crude relative risk of OA rises as the time interval since injury increases. The relative risk of OA has already doubled by 2 years after ACL injury). By 7 years it has increased fivefold and compared with OA status at the time of injury it is still increasing significantly after 10 years. CONCLUSIONS: The ACL injury is a significant risk factor for the development of early-onset secondary knee osteoarthritis. Within 5 years of the injury the knee shows clear signs of osteoarthritis on MRI. However, these lesions are often not associated with any clinical signs. Knee osteoarthritis as a severe disease starts 8 years or later after the injury, when it requires treatment.

[Characteristics of Focal Degenerative Cartilage Lesions in the Knee Joint. A Radiologic, Spectroscopic, Histological and Biochemical Study]. / Eigenschaften fokaler degenerativer Knorpelschäden am Kniegelenk. Eine radiologische, spektroskopische histologische und biochemische Untersuchung.

OBJECTIVE: The aim of this study was to perform a macroscopic, spectroscopic and biochemical/histological examination of the defect margins of grade IIIb cartilage lesions in the patella, the medial femoral condyle, the corresponding articular surface and the remaining cartilage surfaces of the knee joint. Our null hypothesis was that there would be no difference in characteristics between the cartilage surrounding the defect, the corresponding articular surface and the remaining articular surfaces of the knee joint on the one hand and the cartilage within the defect on the other. METHOD: The study included ten patients treated for focal cartilage lesions (ICRS classification grade IIIb) by autologous cartilage transplantation (ACT). All patients underwent a preoperative magnetic resonance imaging scan (1, 5 T). The articular cartilage lesions were classified pursuant to the recommendations of the International Cartilage Repair Society (ICRS). During the arthroscopic procedure, spectroscopic examinations were performed to measure the degree of cartilage degeneration in a total of 14 defined areas including the defect itself and the region of the defect margins. Biopsies for a histological and biochemical examination (collagen II, glycosaminoglycan, DNA) were taken from the centre of the defect and the defect margins that seemed to be intact on macroscopic examination. RESULTS: All knee joints had focal grade IIIb cartilage lesions with an intact margin and an intact corresponding articular surface. The readings obtained on spectroscopic examination both in the defect, the apparently intact margins, the corresponding articular surface and all other examined areas of the knee suggested that severe degenerative changes had already occurred in the cartilage. The histological and biochemical examinations of the residual cartilage in the centre of the defect and the apparently intact margins revealed no significant differences. CONCLUSIONS: Focal cartilage lesions frequently occur in the main weight-bearing zones of the patella and the medial femoral condyle. If they are the result of degenerative changes in the knee joint, the residual cartilage in the defect does not differ from the cartilage of the defect margins, the corresponding articular surface and the other cartilage surfaces. This leads to the conclusion that focal cartilage defects seen in degenerative joint damage are only one aspect of general joint degeneration.

[Knee-related Pain Problems during Pregnancy Correlate with an Increase in Body Weight. Results of a Prospective Study]. / Knieschmerz im Verlauf der Schwangerschaft in Bezug zum Anstieg des Körpergewichts. Ergebnisse einer prospektiven Studie.

PURPOSE: This study aimed to evaluate the incidence of knee pain or the intensification of knee-related problems during pregnancy. We hypothesised that the occurrence of knee problems correlates with an increase in body weight during pregnancy. METHODS: A total of 326 women (30(th)-40(th) week of pregnancy) were involved in this study. At onset of the pregnancy, the patients were 29.4 [95% CI 28.8-29.9] years of age. We asked all patients retrospectively about their anthropometric data at the beginning of pregnancy. All patients provided information about former knee problems, knee problems occurring after onset of pregnancy or any increase in these problems. These knee patients were re-evaluated 6 weeks after childbirth. At follow-up, the patients were asked about their knee problems and about their body weight. RESULTS: At the beginning of pregnancy, the mean body weight was 68.0 kg (95% CI 64.4-69.6; range 41-117). The mean BMI of all patients was 24.5 kg/m² (25% CI 23.9-25.0; range 17.0-26.0). The absolute body weight increased by 13.8 kg (95% CI 13.2-1.5; range 3-38). A total of 24 patients (7.4%) reported new knee problems during pregnancy. 2 patients reported an increase in knee-related problems during pregnancy (0.6%). The incidence of knee-related problems (new cases and increase of problems n=26) was 26/326 or 7.6/100 pregnancies. In patients without knee problems, the pregnancy-related increase in the BMI (ΔBMI) was 4.8 kg/m² (95% CI 4.6-5.1, range 1.1-14.1). In cases with incident knee problems, the ΔBMI was 5.9 kg/m² (95% CI 4.9-6.9, range 2.1-11.8). The increase in body weight (Δbody weight) in patients without knee problems was 13.5 kg (95% CI 12.9-14.2, range 3-38). Patients with incident knee pain experienced a Δbody weight of 16.8 kg (95% CI 13.9-19.4, range 6-35). The differences in ΔBMI and Δbody weight were significant (p=0.009). A Δbody weight >20 kg was a significant risk factor for pregnancy-related knee pain significant risk factor pregnancy related pain. A total of 23 incident cases (92%) underwent a follow-up interview 6 weeks after parturition. At this time, a total of 6 patients (26.1%) had not experienced further knee problems, whereas persistent knee problems were reported in the remaining patients (73.9%). Patients without any knee complaints [body weight 72.5 kg (CI 95% 60.9-83.9)] tended to have a lower body weight at follow-up than patients with persistent knee pain [85.5 kg (CI 95% 71.8-99.1), p=0.162]. CONCLUSION: There is a body weight-associated increase in the incidence of functional knee pain in pregnant women. In about one-third of the cases, knee problems persist after pregnancy and are associated with a residual increase in body weight. Thus, we conclude that body weight is a potential risk factor for functional knee pain.

[Football as risk factor for a non-injury-related knee osteoarthritis - results from a systematic review and metaanalysis]. / Fußballsport als Risikofaktor für nicht unfallbedingte Gonarthrose - Ergebnisse eines systematischen Review mit Metaanalyse.

UNLABELLED: Aim and Hyopthesis: This systematic review and the metanalysis were performed to investigate the relation between football activity and the potential risk of knee osteoarthritis (possible occupational disease). It was hypothesised that soccer players suffer more than controls from knee osteoarthritis also in cases with an absence of documented major injuries. METHODS: The review and the metaanalysis were performed accordingly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. On 2014.02.01 a search was conducted within the medical databases PubMed, Medline, Cochrane, EMBASE und Web-of-Science. A total of 4,649 papers underwent a "Title-Abstract-Review". Finally 6 publications were included in the metaanaylsis. RESULTS: There were no longitudinal community-based studies as well as no Cochrane Reviews regarding the risk of knee osteoarthritis in soccer players. After adjustment of major injuries of the knee, soccer players have a slightly increased risk for knee osteoarthritis: relative risk 1.3 (95 % CI 1.0 - 1.7); I(2) = 37.4 %; p = 0.002. In contrast, in studies without differentiation of injured and non-injured knees, the relative risk was significantly increased: 2.9 (95 % CI 2.0 - 4.1); I(2) = 56.3 %; p < 0.001. CONCLUSIONS: Soccer players are a very heterogeneous group. The soccer player's knee undergoes different loadings including minor and major injuries. But the individual load also strongly depends on the player's status, his position within the football field and many other factors. In the absence of a major trauma the soccer player has only a slightly increased risk for the development of osteoarthritis. Thus we conclude that an injury in professional football does not fulfil the characteristics of an occupational disease.

[The German Cartilage Registry (KnorpelRegister DGOU) for evaluation of surgical treatment for cartilage defects: experience after six months including first demographic data]. / Das KnorpelRegister DGOU zur Erfassung von Behandlungsergebnissen nach Knorpeloperationen: Erfahrungen nach 6 Monaten und erste epidemiologische Daten.

The German Cartilage Registry (KnorpelRegister DGOU) has been introduced in October 2013 and aims on the evaluation of patients who underwent cartilage repair for symptomatic cartilage defects. It represents a nation-wide cohort study which has been introduced by the working group "Tissue Regeneration" of the Germany Society of Orthopaedic Surgery and Traumatology and is technically based upon a web-based remote data entry (RDE) system. The present article describes first experiences with the registry including patient and treatment characteristics. Between October 2013 and April 2014, a total of 230 patients who had undergone surgical cartilage repair for symptomatic full-thickness cartilage defects of the knee has been included in the German Cartilage Registry from 23 cartilage repair centres. Mean age was 37.11 years (SD 13.61) and mean defect size was 3.68 cm(2) (SD 0.23). Since the introduction of the KnorpelRegister DGOU the total number of registered patients has increased steadily up to the most recent figure of 72 patients within one month. Patients were treated mainly according to the recommended therapies. The highest percentage in therapy is represented by the bone marrow stimulation techniques (55.02 %) as well as by the autologous chondrocyte transplantation (34.92 %). Unlike the patient collective in the majority of prospective randomised controlled trials, the patient population within the registry shows a high proportion of patients with accompanying pathologies, with an age of more than 50 years at the time of treatment and with unfavourably assessed accompanying pathologies such as an affection of the opposite cartilage surface or a previously resected meniscus. In summary, the technical platform and forms of documentation of the KnorpelRegister DGOU have proved to be very promising within the first six months. Unlike data from other clinical trials, the previous analysis of the patients' data and therapies reflects successfully the actual medical care situation of patients with cartilage defects of the knee joint. This analysis also provides new information on subgroups of patients that have not yet been recorded in the scientific literature. This will be part of the first analysis of clinical treatment data. An expansion of the KnorpelRegister DGOU to patients with cartilage defects of the ankle and hip joints is already decided upon and initialised.

[Focal cartilage defects within the medial knee compartment. predictors for osteoarthritis progression]. / Fokale Knorpelschäden des medialen Gelenkkompartiments: Prädiktoren für die Progression der Kniearthrose.

AIM: The aim of this study was to evaluate the progression of osteoarthritis (end-stage disease with a requirement for arthroplasty) in patients with focal cartilage defects of the medial knee compartment. MATERIAL AND METHODS: Patients (n = 115) with focal cartilage lesions of the medial knee compartment underwent arthroscopy. The follow-up was performed 10 years after the operation to determine the rate of arthroplasty conversion and to evaluate associated factors. RESULTS: In a total of 35 cases an arthroplasty was needed (30.4 %). The mean survival to arthroplasty was 93.2 (95 % CI 85.4-109.0) months. Cartilage defects within the femur and cartilage lesions within the patella and the lateral did not influence the OA progression. Among the significant risk factors for OA progression were higher patient age, female gender, overweight or obesity and severity of meniscal damage. The most important risk factor was the occurrence and the extent of tibial cartilage defects. CONCLUSIONS: In the natural course, about 30 % of patients with focal cartilage defects of the medial knee compartment undergo rapid OA progression (arthroplasty as end-stage of the disease). There are general risk factors (age, female gender and obesity) but also local risk factors. Furthermore, tibial defects and the extent of meniscus loss influence the outcome significantly. These general and local factors should be more carefully estimated or addressed in future clinical and scientific work.

[The effect of arthroscopic debridement and conservative treatment in knee osteoarthritis: Results of a 5-year follow-up and literature review]. / Die Behandlung moderater Kniegelenksarthrosen durch arthroskopisches Gelenkdebridement: 5-Jahres-Ergebnisse und systematisches Review.

PURPOSE: This study is aimed to compare the effects of arthroscopic joint debridement over a 5-year period in a clearly defined patient population (only grade III knee osteoarthritis, history < 2 years). MATERIAL AND METHODS: A total of 96 patients (50 male and 46 female) underwent arthroscopic knee debridement for knee OA. The main criteria for inclusion were osteoarthritis grade III (Kellgren-Lawrence score) and a maximal history of 2 years. RESULTS: The subjective complaints and the knee-related quality of life were estimated by the KOOS (knee injury and osteoarthritis outcome score). The score increased significantly within the 1 to 3 rd year post operation. After this interval the mean points of the score declined. But after 5 years the KOOS was higher in comparison to the baseline dates. Patients who had undergone conservative treatment at baseline had a significantly different KOOS than patients in the arthroscopy group. Over time, patients in the arthroscopy group had fewer complaints than patients in the conservative treatment group. In both groups, the results decreased over time. A total of 17 patients (17.2 %) needed a conversion to total endoprothetic replacement. The mean time-interval between index operation and conversion was 56.6 (95 % CI 54.4 - 58.4) months. CONCLUSIONS: In middle stages of knee OA, arthroscopic joint debridement can effectively reduce subjective complaints. Because this treatment does not stop the process of OA, the improvements decrease over time.

[Prevalence and distribution of knee cartilage lesions in sportspersons and non-sportspersons: results of a retrospective arthroscopic study]. / Häufigkeit und Verteilung von Knorpelschäden des Kniegelenks bei Sportlern und Nicht-Sportlern: Ergebnisse einer retrospektiven arthroskopischen Studie.

AIM: This study was aimed to evaluate the correlation between sports activity and frequency and grad of non-traumatic knee cartilage lesions. METHODS: A total of 868 patients (469 male and 399 female) who were suffering from knee pain (> 3 months) had undergone knee arthroscopy. The mean duration of history was 11.4 ± 11.5 (3 - 48) months. Criteria for exclusion were major knee injuries (e. g., ACL injuries). All cartilage lesions were classified according to the ICRS (International Cartilage Repair Society) guidelines and summarised with the semiquantitative WOAKS (Whole Organ Arthroscopic Knee Score). RESULTS: There was a significant correlation between cartilage degeneration and age. Older female patients (63 to 85 years) demonstrated higher knee degenerations than male patients. The grade cartilage degeneration was higher in non-sportspersons (WOAKS = 13.5 ± 13.8) than in sportspersons (WOAKS = 7.1 ± 5.3), p < 0.001. Only in younger patients (17 to 34 years) was there no difference in the frequency of cartilage lesions in correlation to sports activity. A high-pivoting sport was significantly more frequently associated with cartilage degeneration in comparison to low-pivoting sports. Cartilage lesions most frequently occur within the mean bearing zones of the medial knee compartment. With regard to sports activity, no differences were observed in the distribution of cartilage lesions. CONCLUSIONS: Sportspersons who suffer from knee pain without injury have significantly less cartilage lesions or, respectively, severe cartilage defects. Cartilage lesions mostly occur within the medial knee compartment without correlation to sports activity and sport type. Patients who are performing "high-pivoting" sports more frequently are suffering from severe cartilage lesions than "low-pivoting" sportspersons. For a final epidemiological estimation of any correlations between sports and cartilage damage, longitudinal MRI studies are needed.

[Evaluation of cartilage degeneration by near infrared spectroscopy (NIRS): methodical description and systematic literature review]. / Bestimmung des Degenerationsgrads am hyalinen Gelenkknorpel durch Nah-Infrarot-Spektroskopie (NIRS): Methodenbeschreibung und Literaturübersicht.

Damage to hyaline cartilage is the most important pathophysiological tool in the development of osteoarthritis. Cartilage lesions are the most frequent pathological findings during arthroscopic operations. Arthroscopies as well as magnetic resonance tomography are gold standards for detection of cartilage lesions. But the arthroscopic evaluation of cartilage lesions is descriptive and subjective only. The surgeon is able to differentiate between intact cartilage surface, softening, superficial or deep fissure or flake and finally a complete defect. In routine arthroscopy the grading mostly is made by use of different scores [e.g. ICRS (International Cartilage Repair Society), Outerbridge, Insall, Jäger-Wirth or others]. Because the arthroscopic evaluation is subjective the reliability of this method is poor. Spectroscopic methods are established for evaluation of different tissue diseases in different indications. NIRS (near infrared spectroscopy) has become an important method for medical diagnostics in the last years. NIR is very energy-rich and suitable for glass fibre transport without relevant reduction. Insofar this technology may be ideal for endoscopic procedures. Our systematic literature review reveals that NIRS is a sufficient method for an objective diagnosis of cartilage lesions. In the current work we demonstrate an NIRS-based device for intraoperative, real-time cartilage evaluation. Furthermore, we discuss the possible clinical consequences from such measurements.

[Metaanalysis for the evaluation of risk factors for carpal tunnel syndrome (CTS) Part I. General factors]. / Metaanalyse zur Bestimmung von Risikofaktoren für das Karpaltunnelsyndrom (KTS) Teil I. Allgemeine Risikofaktoren.

AIM: The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an "occupational disease". This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part I addresses the general factors and possible concurrent factors of CTS. These results may be helpful in later experts' reviews of the "occupational disease CTS". METHODS: A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random effects model. RESULTS: The CTS prevalence in all studies independent of study type was 10.6 % (95 % CI 7.8-14.2). The crude incidence calculated from the longitudinal studies was 10.4 (95 % CI 8.9-11.9)/1000 person years. Female patients more frequently suffered from CTS [OR = 1.9 (95 % CI 1.6-2.2), p < 0.001]. The prevalence of CTS was correlated with an increase in age. The highest prevalence was observed in middle-aged patients (40 to 60 years old). Other significant CTS-associated factors were overweight or obesity [OR = 1.4 (95 % CI 1.3-1.6), p < 0.001]. CTS more frequently occurred in the dominant hand [OR = 1.8 (95 % CI 1.4-2.3), p < 0.001] and in persons of "non-white race" [OR = 1.6 (95 % CI 1.2-1.9), p < 0.001]. Furthermore, CTS was often associated with numerous other general diseases. Real risk factors (results from longitudinal studies) were the following: female gender [OR = 3.7 (95 % CI 2.6-5.2), p < 0.001], middle age [OR = 2.2 (95 % CI 0.9-4.9), p < 0.001], overweight or obesity [OR = 1.5 (95 % CI 1.1-1.9), p < 0.001], diabetes mellitus [OR = 5.3 (95 % CI 1.6-16.8), p < 0.001], and excessive alcohol abuse [OR = 2.3 (95 % CI 0.7-2.3), p < 0.001]. CONCLUSION: CTS is an extremely frequent disease. Independent of occupational burden, many patients are suffering from this frequent peripheral nervous compressive syndrome. These data will be essential in later experts' reviews of the "occupational disease CTS".