Die erste Dekade des KnorpelRegisters der DGOU – Erkenntnisse für die klinische Praxis

Weishorn, Johannes; Bumberger, Alexander; Niemeyer, Philipp; Tischer, Thomas; Mueller-Rath, Ralf; Renkawitz, Tobias; Bangert, Yannic

doi:10.1007/s00132-023-04386-2

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Although there is limited evidence for osteotomies in cartilage regenerative surgery, they have become increasingly popular in recent years [2,19]. Whereas previously, a rather vague threshold of more than 5°of leg malalignment was considered an indication for additional alignment correction, realignment osteotomies are now suggested for as little as 3° [13,30]. This shift is primarily driven by scientific evidence but may also be the result of surgical progress [10,12].…”

Section: Discussionmentioning

confidence: 99%

Neutral to slightly undercorrected mechanical leg alignment provides superior long‐term results in patients undergoing matrix‐associated autologous chondrocyte implantation

Weishorn,

Koch,

Zietzschmann

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to evaluate the role of leg alignment on long‐term clinical outcome after matrix‐associated autologous chondrocyte implantation (M‐ACI) and to define an individualized target range to optimize clinical outcome.MethodsThe present study examined patients who underwent M‐ACI of the femoral condyle. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) were used to assess the results. Clinical outcomes were related to Patient Acceptable Symptomatic State (PASS). For intra‐ and interobserver reliability of mechanical tibiofemoral angle, mechanical medial proximal tibial angle and mechanical lateral distal femoral angle, we calculated intraclass correlation coefficients using a two‐way mixed model with absolute agreement. A regression model and receiver‐operating characteristics curve were used to identify an individual range of alignment where a favourable clinical outcome could be expected in the long term.ResultsAdditional osteotomy was performed in 50% of patients with similar clinical outcomes as physiologically aligned patients (p > 0.05). The curve‐fitting regression model identified a target range of −2.5° valgus to 4.5° varus for ideal postoperative alignment (R2 = 0.12, p = 0.01). Patients within this range were more likely to achieve PASS (70% vs. 27%, p = 0.001). In medially treated defects, a refined range of −2.5° valgus to 4° varus alignment was found (R2 = 0.15, p = 0.01). These patients were more likely to achieve PASS (67% vs. 30%, p = 0.01) and showed favourable postoperative KOOS and MOCART scores (p = 0.02). Patients with lateral defects were more likely to achieve PASS within a range of −2° valgus and 0.5° varus (90% vs. 45%, p = 0.03) and showed favourable postoperative KOOS and MOCART scores (p = not significant).ConclusionsAn individual range of leg alignment—whether achieved by osteotomy or physiologic alignment—should be respected in M‐ACI treatment. A neutral to slightly undercorrected alignment favours the postoperative outcome after M‐ACI. When planning surgery for patients with focal cartilage defects of the femoral condyle, these ranges should be recognized as critical factors.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Neutral to slightly undercorrected mechanical leg alignment provides superior long‐term results in patients undergoing matrix‐associated autologous chondrocyte implantation

Weishorn,

Koch,

Zietzschmann

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…At the time of cartilage biopsy, informed written consent was obtained. Subsequently, at 6, 12, 24, 36 and 60 months postoperatively, patients were automatically contacted by e‐mail to complete a patient‐reported outcome measure (PROM) questionnaire [38].…”

Section: Methodsmentioning

confidence: 99%

The role of autologous bone grafting in matrix‐associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU)

Weishorn,

Tischer,

Niemeyer

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate whether concomitant autologous bone grafting adversely affects clinical outcome and graft survival after matrix‐associated autologous chondrocyte implantation (M‐ACI).MethodsThe present study examines registry data of patients who underwent M‐ACI with or without autologous bone grafting for large‐sized chondral or osteochondral defects. Propensity score matching was performed to exclude potential confounders. A total of 215 patients with similar baseline characteristics were identified. Clinical outcome was assessed at the time of surgery and at 6, 12, 24, 36 and 60 months using the Knee Injury and Osteoarthritis Outcome Score (KOOS). KOOS change, clinical response rate, KOOS subcomponents and failure rate were determined.ResultsPatients treated with M‐ACI and autologous bone grafting achieved comparable clinical outcomes compared with M‐ACI alone. At 24 months postoperatively, the patient‐reported outcome (PRO) of patients treated with M‐ACI and autologous bone grafting was even significantly better as measured by KOOS (74.9 ± 18.8 vs. 79.2 ± 15.4; p = 0.043). However, the difference did not exceed the minimal clinically important difference (MCID). In patients with M‐ACI and autologous bone grafting, a greater change in KOOS relative to baseline was observed at 6 (9.3 ± 14.7 vs. 15.0 ± 14.7; p = 0.004) and 12 months (12.6 ± 17.2 vs. 17.7 ± 14.6; p = 0.035). Overall, a high clinical response rate was observed in both groups at 24 months (75.8% vs. 82.0%; p = n.s.). The estimated survival at the endpoint of reoperation for any reason was 82.1% (SD 2.8) at 8.4 years for isolated M‐ACI and 88.7% (SD 2.4) at 8.2 years for M‐ACI with autologous bone grafting (p = 0.039).ConclusionsEven in the challenging cohort of large osteochondral defects, the additional treatment with autologous bone grafting leads to remarkably good clinical outcomes in patients treated with M‐ACI. In fact, they tend to benefit more from surgery, have lower revision rates and achieve clinical response rates earlier. Subchondral bone management is critical to the success of M‐ACI and should be addressed in the treatment of borderline defects.Level of EvidenceLevel III.

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“…The exclusive focus on a single elite football academy in Germany limits the generalisability of the findings. To improve external validity, future studies could adopt registry structures similar to those used in other sports orthopaedic subspecialties [42]. However, differences in training methods, coaching techniques, and match formats between clubs may limit the comparability of injury rates.…”

Section: Strength and Limitationsmentioning

confidence: 99%

The Impact of Injury on Career Progression in Elite Youth Football—Findings at 10 Years

Bangert,

Jaber,

Trefzer

et al. 2024

JCM

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Background: There is a lack of evidence regarding the impact of time loss, match exposure, and age at injury on career progression in elite football. Therefore, the aim of this study was to identify injury characteristics and their influence on career progression in a German youth academy. Methods: During the 2012/2013 season, a prospective cohort study reported 107 time-loss injuries among 130 young athletes from an elite German soccer academy. Individual career progression was analyzed using 10-year data. Results: Injuries and time loss were not associated with career progression (p > 0.05) in the overall cohort. In the U17 and U19 groups, 24% were able to reach the professional level, with injuries significantly decreasing this probability (p = 0.002). Injuries lasting more than 28 days had a negative impact on career progression compared to minor injuries (30% vs. 10%; p = 0.02). Conclusions: Not only the characteristics of injuries, but also their impact on career development, vary with age. In the U17 and U19 age groups, serious injuries resulting in more than 28 days of absence have a negative impact on career progression. It is important to be aware of these effects in order to focus on the prevention of long-term injuries to ensure the optimal development of young athletes.

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Die erste Dekade des KnorpelRegisters der DGOU – Erkenntnisse für die klinische Praxis

Cited by 5 publications

References 32 publications

Neutral to slightly undercorrected mechanical leg alignment provides superior long‐term results in patients undergoing matrix‐associated autologous chondrocyte implantation

Neutral to slightly undercorrected mechanical leg alignment provides superior long‐term results in patients undergoing matrix‐associated autologous chondrocyte implantation

The role of autologous bone grafting in matrix‐associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU)

The Impact of Injury on Career Progression in Elite Youth Football—Findings at 10 Years

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