Das KnorpelRegister DGOU zur Erfassung von Behandlungsergebnissen nach Knorpeloperationen: Erfahrungen nach 6 Monaten und erste epidemiologische Daten

Zusammenfassung

Das KnorpelRegister DGOU wurde im Oktober 2013 mit dem Ziel der Evaluation und Nachverfolgung von Patienten nach operativer Behandlung von Knorpelschäden eingeführt. Es stellt eine multizentrische Datenbank dar, welche durch die AG Klinische Geweberegeneration der DGOU initiiert wurde. Technisch basiert die Datenbank auf einem webbasierten RDE-System (RDE: Remote Data Entry), welches die automatisierte Nachverfolgung der Patienten über mehrere Jahre ermöglicht. Die vorliegende Arbeit berichtet über erste Erfahrungen mit dem KnorpelRegister DGOU und über patientenspezifische und behandlungsspezifische Charakteristika der bisher im Register dokumentierten Patienten. Zwischen Oktober 2013 und April 2014 wurden insgesamt 230 Patienten nach operativer Behandlung symptomatischer Knorpelschäden am Kniegelenk in 24 Zentren in das Register aufgenommen. Das durchschnittliche Patientenalter betrug 37,11 Jahre (SD 13,61), die durchschnittliche Defektgröße 3,68 cm² (SD 0,23). Seit Einführung des Registers ist die Zahl eingegebener Patienten pro Monat auf zuletzt 72 Patienten kontinuierlich angestiegen. Die durchgeführten Therapien verteilen sich hauptsächlich auf die in entsprechenden Empfehlungen aufgeführten Therapieverfahren. Den prozentual stärksten Anteil stellen hierbei die knochenmarkstimulierenden Verfahren (55,02 %) sowie die autologe Knorpelzelltransplantation dar (34,92 %). Abweichend vom Patientenkollektiv in der Mehrzahl prospektiv randomisierter Studien fallen im KnorpelRegister DGOU ein hoher Anteil an Patienten mit Begleitpathologien, ein relevanter Patientenanteil mit einem Alter von mehr als 50 Jahren zum Behandlungszeitpunkt sowie auch ein signifikanter Anteil von Patienten mit als ungünstig eingeschätzten Begleitpathologien, wie z. B. einer Affektion der gegenüberliegenden Knorpelfläche oder einem vorausgehend resezierten Meniskus, auf. Zusammenfassend hat sich innerhalb der ersten 6 Monate die technische Plattform und Dokumentationsform des KnorpelRegisters DGOU als erfolgreich und vielversprechend erwiesen. Die bisherige Analyse der eingegebenen Patienten und Therapien lässt schlussfolgern, dass das Register, anders als viele Studien, die Versorgungsrealität von Patienten mit Knorpelschäden am Kniegelenk erfolgreich abbilden kann und auch neue Informationen über Subgruppen von Patienten generiert werden können, die bisher in der wissenschaftlichen Literatur noch nicht abgebildet sind. Dies wird Teil der ersten Analyse klinischer Behandlungsdaten sein. Eine Ausweitung des KnorpelRegisters DGOU auf Patienten mit Knorpelschäden am Sprung- und Hüftgelenk ist bereits beschlossen und initialisiert.

Abstract

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 cm² (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 patientsʼ 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.

Schlüsselwörter

Knorpelschaden - Kniegelenk - Register - Knochenmarkstimulation - Zelltherapie

Key words

cartilage defect - knee joint - registry - bone marrow stimulation - cell transplantation

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