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Z Orthop Unfall 2013; 151(5): 468-474
DOI: 10.1055/s-0033-1350707
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Georg Thieme Verlag KG Stuttgart · New York

Wirkung von passiven Motorbewegungsschienen nach knorpelregenerativen Eingriffen – eine systematische Literaturübersicht

Effect of Continuous Passive Motion for Cartilage Regenerative Surgery – a Systematic Literature Review
S. Rogan
1   Physiotherapie, Berner Fachhochschule, Schweiz
,
J. Taeymans
1   Physiotherapie, Berner Fachhochschule, Schweiz
,
A. Hirschmüller
2   Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Chirurgische Klinik, Freiburg im Breisgau
,
P. Niemeyer
2   Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Chirurgische Klinik, Freiburg im Breisgau
,
H. Baur
1   Physiotherapie, Berner Fachhochschule, Schweiz
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
15. Oktober 2013 (online)

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Zusammenfassung

Hintergrund: Eine systematische Literaturübersicht untersuchte den Effekt von passiven Motorbewegungsschienen (CPM) nach knorpelregenerativen Operationen am Kniegelenk. Patienten/Material und Methode: Die Suche erfolgte in MEDLINE, Cochrane Central Register, EMBASE, International Clinical Trials Registry Platform, Trip Database und im Literaturverzeichnis der eingeschlossenen Studien. Zwei unabhängige Personen prüften die Qualität der Originalarbeiten anhand des Cochrane Risk of Bias-Instruments und Übersichtsarbeiten anhand der CBO/Dutch Cochrane Centre-Richtlinie. Ergebnisse: Es wurden 1541 Studien gesichtet. Eine Übersichtsarbeit und 9 Originalarbeiten wurden anschließend für die Analyse ausgewählt. Aufgrund der methodologischen Schwächen der Studien, der Heterogenität der Outcome-Variablen und der Tatsache, dass 6 von 9 Studien mithilfe eines 1-Gruppen-Designs mit Vorher-Nachher-Messung den kombinierten Effekt von operativer Therapie und CPM erfasst haben, war eine Metaanalyse nicht durchführbar. Schlussfolgerung: Drei (Fall-)Studien geben signifikante Verbesserungen hinsichtlich subjektiver Fragebogen-Scores wie Schmerz, Schwellung, Quality of Life Survey, Knee Society Score, Cincinnati Rating Score oder WOMAC aufgrund der operativen Versorgung und der CPM-Intervention nach Knorpeldefekten am Knie an. Sechs (Fall-)Studien zeigen eine verbesserte Knorpelqualität und ein besseres subjektives Outcome der Patienten nach CPM auf, jedoch ohne statistische Signifikanz. Um diese Therapieeffekte auf einem höheren Evidenzlevel nachzuweisen, sind weitere hochwertige randomisiert-kontrollierte Studien erforderlich.

Abstract

Background: The aim of this systematic review was to evaluate treatment effects of continuous passive motion (CPM) after surgical cartilage repair. Patients/Material and Methods: A literature search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, International Clinical Trials Registry Platform, MEDLINE, Trip Database and in bibliographies of included studies. Two independent researchers evaluated the quality of original investigations by the Cochrane Risk of Bias tool. Systematic reviews were checked by the CBO/Dutch Cochrane Centre Guideline. Results: A total of 1541 studies was initially retrieved from the databases. After screening for inclusion criteria, one review and ten original papers could be included for further evaluation. Studies showed methodological weaknesses. Heterogeneity of outcome measures and the fact that 6 of 9 studies with an one-group pre-post design measured the combined effect of surgical treatment and CPM prevented a meta-analysis. Conclusion: Three studies described significant improvements with regard to subjective outcome such as pain, swelling, Quality Life Survey, Knee Society score, WOMAC score or rating Cincinnati due to the surgical treatment and the CPM intervention of cartilage defects in the knee. Six (case) studies suggested an enhanced cartilage quality of the patients after CPM. More high-quality randomised controlled trials are needed to provide high level evidence.

Schlüsselwörter

hyaliner Knorpel - Regeneration - Belastung - autologe Knorpelzelltransplantation - Mikrofrakturierung

Key words

hyaline cartilage - regeneration - stress - autologue chondrocyte implantation - microfracturing
 

  • Literatur

  • 1 Steinwachs MR. Die Behandlung von Gelenkknorpelschäden. Rheumatologie 2008; 3: 7-12
    PubMedSuche in Google Scholar
  • 2 Pridie K. A method of resurfacing ostheoarthritic knee joints. J Bone Joint Surgery 1959; 41: 618-619
    PubMedSuche in Google Scholar
  • 3 Sprague N. Arthroscopic debridement for degenerative knee joint disease. Clin Orthop 1991; 160: 118-123
    PubMedSuche in Google Scholar
  • 4 Hangody L, Kish G, Karpati Z et al. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics 1998; 21: 751-756
    PubMedSuche in Google Scholar
  • 5 Brittberg M, Lindahl A, Nilsson A et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994; 331: 889-895
    CrossrefPubMedSuche in Google Scholar
  • 6 Niemeyer P, Andereya S, Angele P et al. [Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group „Tissue Regeneration“ of the German Society of Orthopaedic Surgery and Traumatology (DGOU)]. Z Orthop Unfall 2013; 151: 38-47
    Thieme ConnectPubMedSuche in Google Scholar
  • 7 Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 2009; 91: 1778-1790
    PubMedSuche in Google Scholar
  • 8 Vaquero J, Forriol F. Knee chondral injuries: clinical treatment strategies and experimental models. Injury 2012; 43: 694-705
    CrossrefPubMedSuche in Google Scholar
  • 9 Preis S, Erggelet C. Therapie von Knorpelschäden mit Autologer Chondrocytenimplantation (ACI). Deutsche Zeitschrift für Sportmedizin 2003; 54: 225-228
    PubMedSuche in Google Scholar
  • 10 Schönle C. Rehabilitation. Stuttgart: Thieme; 2004
    Suche in Google Scholar
  • 11 Salter RB, Simmonds DF, Malcolm BW et al. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 1980; 62: 1232-1251
    PubMedSuche in Google Scholar
  • 12 OʼDriscoll SW, Keeley FW, Salter RB. The chondrogenic potential of free autogenous periosteal grafts for biological resurfacing of major full-thickness defects in joint surfaces under the influence of continuous passive motion. An experimental investigation in the rabbit. J Bone Joint Surgery Am 1986; 68: 1017-1035
    PubMedSuche in Google Scholar
  • 13 Liberati A, Altman DG, Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
    CrossrefPubMedSuche in Google Scholar
  • 14 Sackett DL, Straus SE, Richardson W et al. Evidence based Medicine. How to practice and teach EBM. 2nd. ed. Edinburgh, New York: Churchill Livingstone; 2000: 261
    Suche in Google Scholar
  • 15 Higgins J, Green S eds. Cochrane Handbook for systematic Reviews of Interventions. Chichester (West Sussex): John Wiley & Sons Ltd; 2008
    CrossrefSuche in Google Scholar
  • 16 Müller JM, Christiaans L, van der Wurff P. [Physical activity and cognitive function in the ageing process – literature review]. Physioscience 2009; 5: 143-150
    Thieme ConnectPubMedSuche in Google Scholar
  • 17 Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
    CrossrefPubMedSuche in Google Scholar
  • 18 Schultz W, Göbel D. Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques. Knee Surg Sports Traumatol Arthrosc 1999; 7: 29-36
    CrossrefPubMedSuche in Google Scholar
  • 19 Chanlalit C, Kasemkijwattanamd C, Varavit V. Autologous chondrocyte implantation for traumatic large cartilage defect. J Med Assoc Thai 2007; 90: 1435-1442
    PubMedSuche in Google Scholar
  • 20 Theodoropoulos J, Dwyer T, Whelan D et al. Microfracture for knee chondral defects: a survey of surgical practice among Canadian orthopedic surgeons. Knee Surg Sports Traumatol Arthrosc 2012; 20: 2430-2437
    CrossrefPubMedSuche in Google Scholar
  • 21 Gillogly SD, Voight M, Blackburn T. Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther 1998; 28: 241-251
    CrossrefPubMedSuche in Google Scholar
  • 22 Nugent-Derfus GE, Takara T, OʼNeill JK et al. Continuous passive motion applied to whole joints stimulates chondrocyte biosynthesis of PRG4. Osteoarthritis Cartilage 2007; 15: 566-574
    CrossrefPubMedSuche in Google Scholar
  • 23 Alfredson H, Lorentzon R. Superior results with continuous passive motion compared to active motion after periosteal transplantation. A retrospective study of human patella cartilage defect treatment. Knee Surg Sports Traumatol Arthrosc 1999; 7: 232-238
    CrossrefPubMedSuche in Google Scholar
  • 24 Marder RA, Hopkins jr. G, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy 2005; 21: 152-158
    PubMedSuche in Google Scholar
  • 25 Rodrigo J, Steadman J, Silliman J et al. Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg 1994; 7: 109-116
    PubMedSuche in Google Scholar
  • 26 Alfredson H, Thorsen K, Lorentzon R. Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation. Knee Surg Sports Traumatol Arthrosc 1999; 7: 69-74
    CrossrefPubMedSuche in Google Scholar
  • 27 Lorentzon R, Alfredson H, Hildingsson C. Treatment of deep cartilage defects of the patella with periosteal transplantation. Knee Surg Sports Traumatol Arthrosc 1998; 6: 202-208
    CrossrefPubMedSuche in Google Scholar
  • 28 Saw KY, Anz A, Merican S et al. Articular cartilage regeneration with autologous peripheral blood progenitor cells and hyaluronic acid after arthroscopic subchondral drilling: a report of 5 cases with histology. Arthroscopy 2011; 27: 493-506
    CrossrefPubMedSuche in Google Scholar
  • 29 Minas T, Gomoll AH, Solhpour S et al. Autologous chondrocyte implantation for joint preservation in patients with early osteoarthritis. Clin Orthop Relat Res 2010; 468: 147-157
    CrossrefPubMedSuche in Google Scholar
  • 30 Steadman RJ, Briggs KK, Rodrigo JJ et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 2003; 19: 477-484
    CrossrefPubMedSuche in Google Scholar
  • 31 Goebel S, Steinert A, Rucker A et al. [Minimally invasive retrograde drilling of osteochondral lesions of the femur using an arthroscopic drill guide]. Oper Orthop Traumatol 2011; 23: 111-120
    CrossrefPubMedSuche in Google Scholar
  • 32 Fazalare JA, Griesser MJ, Siston RA et al. The use of continuous passive motion following knee cartilage defect surgery: a systematic review. Orthopedics 2010; 33: 878
    PubMedSuche in Google Scholar
  • 33 Viswanathan M, Ansari MT, Berkman ND et al. Assessing the Risk of Bias of individual Studies in systematic Reviews of Health Care Interventions. In: Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Agency for Healthcare Research and Quality Methods Guide for Effectiveness Reviews. AHRQ Publication No. 12 – EHC047-EF. Available at: http://www.effectivehealthcare.ahrq.gov/ accessed: March 2012
    PubMed
  • 34 Barrett GR, Richardson K Ruff CGet al. The effect of suture type on meniscus repair. A clinical analysis. Am J Knee Surg 1997; 10: 2-9
    PubMedSuche in Google Scholar
  • 35 Petersen W, Zantop T. Das vordere Kreuzband: Grundlagen und aktuelle Praxis der operativen Therapie. Köln: Deutscher Ärzte-Verlag; 2009
    CrossrefSuche in Google Scholar
  • 36 Egger M, Smith GD, Altman DG. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd. ed. London: John Wiley & Sons; 2001
    CrossrefSuche in Google Scholar
  • 37 Hirschmüller A, Baur H, Braun S et al. Rehabilitation after autologous chondrocyte implantation for isolated cartilage defects of the knee. Am J Sports Med 2011; 39: 2686-2696
    CrossrefPubMedSuche in Google Scholar
  • 38 OʼDriscoll SW, Salter RB. The repair of major osteochondral defects in joint surfaces by neochondrogenesis with autogenous osteoperiosteal grafts stimulated by continuous passive motion. An experimental investigation in the rabbit. Clinical Orthop Relat Res 1986; 208: 131-140
    PubMedSuche in Google Scholar