Fragestellung: Die Gonarthrose ist eine der häufigsten Erkrankungen des höheren Lebensalters. Es besteht daher der Bedarf, das Ausmaß der radiologischen Veränderungen am Kniegelenk zu quantifizieren. Diesbezüglich wurden im Verlauf der letzten Jahre einige Bewertungsschemata publiziert. Ziel dieser Studie war es, eine Messmethode auszuwählen, welche für die Arbeit in der klinischen Praxis geeignet scheint. Material und Methode: Eine ausführliche Internetsuche listete alle bis dato publizierten Begutachtungsmethoden sowie Arbeiten über metrologische Aspekte zu diesem Thema auf. Die verschiedenen Skalen wurden auf Validität, Reliabilität und Praktikabilität hin überprüft. Da exakte Vermessung der radiologischen Veränderungen für die klinische Praxis zu aufwändig erschien, wurden lediglich semiquantitative Methoden inkludiert. Ergebnisse: Im Gegensatz zu klinischen Scores wie WOMAC oder Lequesne gibt es für radiologische Scores keine Validierungsstudien. Hinsichtlich Reliabilität sind lediglich der Kellgren-u.-Lawrence-Score, der OARS-Atlas von Altman et al. und der Konturzeichnungsatlas von Nagaosa et al. ausreichend dokumentiert. Schlussfolgerung: Aus unserer Sicht stellte der letztgenannte die beste Methode dar, in der Praxis das Ausmaß des strukturellen Schadens bei Gonarthrosen auf effiziente und verlässliche Art zu beurteilen.
Abstract
Purpose: Osteoarthritis of the knee is one of the most common diseases in the elderly. There is a certain need to quantify the extent of the radiological changes to the joint. Throughout the years several scores have been published in order to meet this demand. The aim of this study was to select a method of assessment fit for clinical practice. Material and methods: A thorough internet search listed all radiographic grading scales published to this day as well as publications on metrological aspects. The various grading scales published so far were evaluated for validity, reliability and practicability. As exact measurements of the radiographic changes proved to be too time consuming for daily clinical use, only semiquantitative methods were included. Results: Compared to clinical grading scales like WOMAC or Lequesne, we found that none of these grading scales had been validated. In terms of reliability, only the Kellgren and Lawrence score, the OARS-Atlas by Altman et al. and the line drawing atlas by Nagaosa et al. were sufficiently documented. Conclusions: We found that the latter was the most convenient method to assess the structural damage of the knee joint in an efficient and reliable way.
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