S. Fickert (Straubing, DE)
Sporthopaedicum Straubing - University Heidelberg Medical Faculty MannheimPresenter Of 2 Presentations
12.1.2 - Cartilage register of german speaking countries-4 year results of the module Hip
Abstract
Purpose
The German Cartilage Registry (GCR) has been extended by the hip module in 2014. It represents a german- speaking cohort study (Germany, Switzerland and Austria) which has been introduced by the working group „tissue regeneration“ of the DGOU. In times of evidence-based medicine the GCR should provide a basis for long-term observational studies to represent the clinical reality of care and assess the effectiveness and efficiency of the therapies used
Methods and Materials
A total of 1019 patients with cartilage defects at the hip (inclusion period 10/2014 to 08/2018) were included. Data collection was performed using a web-based remote data entry (RDE) system. All data were provided by the attending physician at the time of surgery of the affected hip.
Results
A total number of 23 centers were involved in this multicenter study. Mean patient age was 37,0 ± 12,1y. In 55.9% (514/919) of the cases, cartilage damage ICRS grade 3 or higher was documented. In more than 91% of cases cartilage damage was associated with a corresponding labrum damage greater than 1/3. Previous hip surgery was rare with 4.6% (46/995). Femoroacetabular impingement represents in 79.1% the main pathology. The mean defect size was 1.7 +/- 1.0 cm2. The most commonly used treatment was debridement (44.2%), in which 57.4% (218/405) of the cartilage defects were ICRS less than or equal to 2. In cartilage defect grade 3 and higher, debridement continued to be the most common surgical technique (34.6%, 176/508), but also BM techniques and ACI (30.1%, 163/508) as well as combination interventions (25.8%, 131/508) were used.
Conclusion
Over the last four years, the GCR has established itself as the benchmark for documenting and tracking patients with cartilage damage in the lower extremity. The present epidemiological analysis of the available data represents the current, mostly arthroscopic supply situation of cartilage damage in the hip area.
12.1.5 - 24 months after arthroscopic matrix-associated ACT of the hip –significant improvement of PROs and MRI using an injectable hydrogel
Abstract
Purpose
The treatment of acetabular chondral lesions has the most significant impact on outcome in Femoroacetabular impingement. For large full-thickness cartilage defects arthroscopic matrix-associated autologous chondrocyte transplantation (MACT) using an injectable in situ crosslinking product is an option. Aim of the study was to evaluate clinical and MRI results 24 months after MACT of acetabular cartilage defects in FAI patients.
Methods and Materials
21 patients with a focal cartilage defect of the hip (2.97 ± 1.44 cm² (mean ± SD) caused by FAI were included. The treatment of associated pathologies and the harvesting of cartilage was performed in the first operation. After cultivation MACT was conducted arthroscopically. The results were assessed with patient-reported outcome measures (iHOT33, EQ-5D) pre- as well as postoperatively and by MRI using MOCART scoring system 6, 12 and 24 months post-operatively.
Results
The iHOT33 score improved from 52.9 ± 21.1 (mean ± SD) preoperative to 85.8 ± 14,8 (mean ± SD; p= 0.0012) 24 months postoperative. The change in the iHOT33 score at 24 months compared with preoperatively was with 33.6 ± 25.3 (MW ± SD); p <0.0001) points very high. Patients showed a significant improvement in quality of life after 24 months as measured by the EQ-5D-5L index (p = 0.0004) and EQ-5D VAS (p = 0.0006). In the 24-month MRI analysis, 11 out of 14 patients showed a complete filling of the defect area and in all 14 patients a complete healing of the graft, the MOCART score (maximum achievable score 85) improved from 62.5 ± 18.3 after 12 months to 72 , 9 ± 10.7 (MW ± SD) at 24 months.
Conclusion
Injectable MACT is a promising minimally invasive treatment option for full-thickness cartilage defects of the hip caused by FAI. A significant improvement in function and quality of life despite large cartilage defects had been detected in the study population.