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Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence

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Abstract

Purpose

Although traumatic osteochondral fractures of the knee represent a common pathology of the knee joint, there is no general agreement concerning specific treatment of this entity. This meta-analysis was initiated in order to evaluate scientific evidence on different treatment options for acute osteochondral fractures of the knee.

Methods

For this purpose an OVID-based systematic literature search was performed including the following databases: MEDLINE, MEDLINE preprints, Embase, CINAHL, Life Science Citations, British National Library of Health and Cochrane Central Register of Controlled Trials. The literature search period was from 1946 to January 2012, which led to the identification of 1,226 articles. After applying study-specific inclusion criteria a total of 19 studies with clinical follow-up of 638 patients were included. The methodology of these studies was systematically analysed by means of the Coleman Methodology Score. Outcome and success rates were evaluated depending on treatment applied.

Results

All studies (n = 19) identified represent case series (evidence-based medicine level IV) and included a total of 638 patients. The average post-operative follow-up was 46 ± 27 months (range 3.75–108). The mean number of study subjects per study was 33 ± 44 patients (range 4–169). The average Coleman Methodology Score was 29 ± 17 points (range 5–72). Six different scoring systems were used for clinical assessment. The overall clinical success rate was 83 % and varied between 45 and 100 %.

Conclusions

This meta-analysis reveals a significant lack of scientific evidence for treatment of osteochondral fractures of the knee. No valid conclusion can be drawn from this study concerning the recommendation of a specific treatment algorithm. Nevertheless, the overall failure rate of 17 % underlines that an acute osteochondral fracture of the knee represents an important pathology which is not a self-limiting injury and needs further investigation.

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Authors and Affiliations

  1. Orthopedic Surgery & Traumatology, Freiburg University Hospital, Freiburg, Germany

    Jan Kühle, Gian Salzmann & Philipp Niemeyer

  2. Trauma Department, Regensburg University Hospital, Regensburg, Germany

    Peter Angele

  3. Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Göttingen, Göttingen, Germany

    Peter Balcarek

  4. Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Innsbruck, Austria

    Martin Eichinger & Ralf Rosenberger

  5. Department of Orthopedic Sports Medicine, Technical University Munich, Munich, Germany

    Matthias Feucht

  6. Trauma Surgery, University Hospital Hanover, Hanover, Germany

    Carl Haasper

  7. Department of Trauma Surgery and Sports Medicine, Academic Hospital Feldkirch, Feldkirch, Austria

    Gohm Alexander

  8. Arthroscopy and Sports Medicine, Charite University Hospital, Berlin, Germany

    Tobias Jung

  9. Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hanover, Hanover, Germany

    Helmut Lill & Christine Voigt

  10. Department of Trauma, Reconstructive and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany

    Bastian Marquass

  11. Academic Department of Trauma Surgery and Sports Medicine, Hospital Feldkirch, Feldkirch, Germany

    Michael Osti

  12. Department of Orthobiology and Cartilage Repair, Schulthess Clinic, Zurich, Switzerland

    Matthias Steinwachs

  13. Department of Orthopedic Sports Medicine, Hessing Clinic, Augsburg, Germany

    Stephan Vogt

  14. Trauma and Orthopedic Department, Johannes Wesling Klinikum Minden, Minden, Germany

    Johannes Zeichen

Authors
  1. Jan Kühle
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  2. Peter Angele
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  7. Gohm Alexander
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  8. Tobias Jung
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  9. Helmut Lill
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  11. Michael Osti
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  12. Ralf Rosenberger
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  14. Matthias Steinwachs
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  15. Christine Voigt
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  16. Stephan Vogt
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  17. Johannes Zeichen
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  18. Philipp Niemeyer
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Correspondence to Philipp Niemeyer.

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Kühle, J., Angele, P., Balcarek, P. et al. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. International Orthopaedics (SICOT) 37, 2385–2394 (2013). https://doi.org/10.1007/s00264-013-2070-7

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  • DOI: https://doi.org/10.1007/s00264-013-2070-7

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