Metaanalyse zur Bestimmung des relativen Risikos posttraumatischer Gonarthrosen

Zusammenfassung

Zielstellung:

Anliegen der hier vorgestellten Metaanalyse war die Ermittlung der durchschnittlichen Arthroserate (ER ROA=event rate der radiologischen Kniearthrose) nach kniegelenksnahen Verletzungen (minimum-follow-up 10 Jahre). Des Weiteren sollte das relative Risiko (OR=Odds Ratio) einer posttraumatischen ROA im Vergleich zum Bevölkerungsdurchschnitt bestimmt werden.

Material und Methode:

Mit Stichtag 28.2.2010 wurde eine systemische Recherche der Datenbank PubMed durchgeführt. Dabei wurde folgende Suchstrategie (Keyword and MeSH) angewendet: [knee] and [osteoarthritis] and [„special injury“]. Unter „special injury“. Außerdem wurden zur Bestimmung der Normalwerte Studien zur allgemeinen Prävalenz der ROA ermittelt. Eingeschlossen wurden nur Arbeiten in englischer und deutscher Sprache und einem minimalen Nachuntersuchungszeitraum von 10 Jahren. Des Weiteren wurde eine klar definierte radiologische Arthrosebewertung gefordert, die einen Vergleich mit der Kellgren-Lawrence-Klassifika­tion (KL-Grad) zuließ. Eine ROA KL 2+ wurde als manifeste Arthrose gewertet. Das relative Risiko wird als OR (Odds Ratio mit 95% CI), berechnet im fixed effect model, angegeben.

Ergebnisse:

Bei der Suche nach den Stichwörtern „[Osteoarthritis] and [Knee] and [Prevalence]“ wurden in PubMed zunächst 1 428 Arbeiten gefunden. Nach Volltextlesung (n=76) wurden 18 Publikationen in die Metaanalyse aufgenommen. Die Gesamtprävalenz der ROA in der Bevölkerung beträgt ohne Adjustierung auf Alter und Geschlecht 27,1 (CI 95% 26,6–27,7). Die Arthroserate nach Kreuzbandriss betrug 42,0 (CI 95% 39,8–44,2)%. Beim Vergleich mit den Normalwerten der Bevölkerung haben Patienten nach einer ACL-Verletzung ein signifikant höheres relatives Risiko, eine ROA zu erleiden (OR= 2,5 (CI 95% 2,3–2,7); p<0,001). Die Arthroserate nach Riss des hinteren Kreuzbandes in insgesamt 3 Studien belief sich auf 29,2 (CI 95% 20,9–39,1)%. Verglichen mit dem relativen Risiko einer ROA der Normalbevölkerung erhöht sich das relative Risiko tendenziell mit einer OR=1,3 (CI 95% 0,8–1,9), p=0,263. Insgesamt beträgt die ER einer ROA nach kniegelenksnaher Fraktur 29,7 (CI 95% 26,4–33,2)%. Das relative Risikos einer ROA nach kniegelenksnaher Fraktur steigt im Vergleich zur Normalpopulation nur ein tendenziell (OR=1,2 (CI 95% 1,0–1,3), p=0,05).

Schlussfolgerungen:

Kniegelenksnahe Verletzungen erhöhen das Risiko eine Arthrose zu erleiden Sinnfehler: ohne Verletzung keine posttraumatische Arthrose. Derzeit adressieren traumatologische Langzeitbeobachtungen in erster Linie das klinische Outcome, die Komplikationsraten und therapietechnische Details. Dagegen sind Studien zur (alters- und geschlechtsadjustierten) posttraumatischen Arthroserate eher die Ausnahme. Hier ergibt sich aus Sicht der Autoren die dringende Notwendigkeit kontrollierter radiologischer Langzeitstudien, die ein Verständnis des Krankheitsbilds „posttraumatische Gonarthrose“ ermöglichen.

Abstract

Introduction:

This metaanalysis was performed to evaluate the event rate of radiological knee osteoarthritis (ER ROA) after knee injuries (minimum 10 year follow-up). Furthermore was aimed to compare the ROA after knee injury with the ROA within the normal population.

Materials and methods:

At deadline 28.2.2010 was performed a systematic PubMed recherché by 2 independent investigators. The search strategy was (MeSH): [knee] and [osteoarthritis] and [special injury]. Furthermore the normal ROA was evaluated for the “normal population”.Criteria for inclusion were papers in German or English language, minimum follow-up and clear-defined radiological osteoarthritis grading accordingly to the Kellgren-Lawrence (KL) scale. A KL-grade of 2 + was accepted as manifest radiological knee osteoarthritis.The relative risk of ROA was calculated in fixed effect model and is expressed as relative risk (odd ratio OR (CI 95%)).

Results:

A total of 1 428 publications were found as result of the search the keywords ­[osteoarthritis] and [knee] and prevalence]. A total of 18 publications were included in the metaanalysis. The ROA of the “normal population” with­out adjustment to sex or age was 27.1 (CI 95% 26.6–27.7)%.The ROA after ACL-injury was 42.0 (CI 95% 39.8–44.2)%. Compared with the normal population increases an ACL-injury the ROA significantly (OR=2.5 (CI 95% 2.3–2.7), p<0.001). Patients after PCL-injury have a higher risk of ROA in tendency (OR=1.3 (CI 95% 0.8–1.9), p=0.263.Fractures near the knee joint increases the risk of ROA in tendency (OR=1.2 (CI 95% 1.0–1.3), p=0.05).

Conclusions:

Knee joint injuries are doubtless risk factors for an increased ROA. The most traumatologic outcome studies don’t address the ROA. The most default of most studies is the lack of information about sex or age adjusted ROA. In future long-term follow-ups for evaluation of the age and sex adjusted ROA are needed for better understanding the progression a “posttraumatic osteoarthritis”.

Schlüsselwörter

Knie - Arthrose - Trauma - Risikofaktor - Metaanalyse

Key words

knee - osteoarthritis - injury - risk factor - metaanalysis

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