Wirkung von passiven Motorbewegungsschienen nach knorpelregenerativen Eingriffen – eine systematische Literaturübersicht

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

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