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Degenerative isolated cartilage defects of the patellofemoral joint are associated with more severe symptoms compared to trauma-related defects: results of the German Cartilage Registry (KnorpelRegister DGOU)

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to utilize data from the German Cartilage Registry (KnorpelRegister DGOU) to examine the hypothesis that degenerative cartilage defects of the patellofemoral joint are associated with more severe clinical symptoms compared to trauma-related defects.

Methods

All patients with isolated focal cartilage defects of the patellofemoral joint registered in the German Cartilage Registry until May 2017 were included in the study. Patients with previous surgery of the ipsilateral knee were excluded. Baseline data including etiology (traumatic, degenerative), size, location and ICRS grade of the cartilage defects as well as the duration of symptoms were analyzed. Clinical symptoms were evaluated by means of the numeric analog scale (NAS) for pain and the Knee injury and Osteoarthritis Outcome Score (KOOS). Group comparisons were performed using the Mann–Whitney-U test along with the Chi-squared test and Fisher’s exact test. A bivariate correlation analysis and a multivariable linear regression analysis were performed to investigate the association between the defect characteristics and the clinical scores.

Results

A total of 423 patients (203 traumatic and 220 degenerative defects) were included. Isolated degenerative cartilage defects were found to have significantly more trochlear locations (28% vs. 18%; p = 0.006), significantly less ICRS grade 4 lesions (50% vs. 73%; p = 0.002) and a significantly smaller defect size [median 300 (IQR 105–400) vs. 300 (200–400) mm2] when compared to those from traumatic etiology. Traumatic defects showed significantly better KOOS-ADL [77 (60–90) vs. 69 (56–82); p = 0.005], KOOS-pain [69 (56–81) vs. 61 (47–75); p = 0.001] and NAS [2 (1–5) vs. 4 (1–6); p = 0.005] scores compared to degenerative defects. The correlation analysis revealed only weak correlations between the quantitative defect characteristics and clinical scores.

Conclusions

Degenerative isolated cartilage defects in the patellofemoral joint are associated with more severe clinical symptoms in comparison to trauma-related defects. Additionally, they show a larger variance regarding their location with more trochlear defects.

Level of evidence

III.

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Funding

The German Cartilage Registry (KnorpelRegister DGOU) is funded by the Deutsche Arthrose-Hilfe and by the Stiftung Oskar-Helene-Heim. This support affects the collection of the registry’s raw data. The sponsors were not involved in the design of present study, in the analysis and interpretation of data, in the writing or the approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany

    Julian Mehl, A. Otto, L. Willinger, A. B. Imhoff & A. Schmitt

  2. Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Munich, Germany

    A. Hapfelmeier

  3. OCM Clinic, Munich, Germany

    P. Niemeyer

  4. Department for Traumatology, Universitätsklinikum Regensburg, Regensburg, Germany

    P. Angele

  5. Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany

    W. Zinser

  6. Center of Trauma and Orthopaedic Surgery Eisenach, Jena University Hospital, Eisenach, Germany

    G. Spahn

Authors
  1. Julian Mehl
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  2. A. Otto
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  3. L. Willinger
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Contributions

All authors contributed to the conception and design of the study. All authors except for AH were responsible for acquisition of data. JM, AO, AH and AS contributed to analysis and interpretation of data. All authors were responsible for drafting or revising the article and approved the final version of this manuscript.

Corresponding author

Correspondence to Julian Mehl.

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Conflict of interest

P.A. reports consulting for Arthrex and Aesculap outside the submitted work. P.N. reports consulting for Arthrex and honoraria from Codon, Stryker and Aesculap outside the submitted work. A.B.I. reports consulting for Arthrosurface and medi and royalties from Arthrex and Arthrosurface outside the submitted work. W.Z. reports grants from Codon and honoraria from Plasmaconcept outside the submitted work. All other authors declare that they have no conflicts of interest.

Ethical approval

The German Cartilage Registry is conducted in accordance with the 1964 Declaration of Helsinki and registered at germanctr.de (DRKS00005617). The registration of data was approved by the local ethics committees of every participating institution. Primary approval was given by the ethics committee at the University of Freiburg (No. 520/14).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Mehl, J., Otto, A., Willinger, L. et al. Degenerative isolated cartilage defects of the patellofemoral joint are associated with more severe symptoms compared to trauma-related defects: results of the German Cartilage Registry (KnorpelRegister DGOU). Knee Surg Sports Traumatol Arthrosc 27, 580–589 (2019). https://doi.org/10.1007/s00167-018-5184-z

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