Return-to-Play and Rehabilitation Protocols following Cartilage Restoration Procedures of the Knee: A Systematic Review

Hurley, Eoghan T.; Davey, Martin S.; Jamal, M. Shazil; Manjunath, Amit K.; Alaia, Michael J.; Strauss, Eric J.

doi:10.1177/1947603519894733

Cited by 34 publications

(37 citation statements)

References 25 publications

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“…This systematic review identified 6 studies evaluating outcomes for distal tibial lesions. 3,10,18,20,24,29 This is in contrast to a systematic review on treatment of OLTs published a decade ago identifying >50 studies. 42 The limited data on OLTPs likely reflect the relatively low incidence of OLTPs relative to OLTs.…”

Section: Discussionmentioning

confidence: 81%

“…Ten articles were included in the review ( Figure 1 , Table 1 ). 2 , 3 , 5 , 10 , 13 , 18 , 20 , 24 , 29 , 36 All studies were published in 2000 or later and were deemed level 4 evidence, except for Elias et al 15 The mean Methodological Index for Non-randomized Studies score of the 5 surgical treatment studies 3 , 12 , 23 , 27 , 33 was 8.6 (range, 8-10); each of these was a noncomparative case series.…”

Section: Resultsmentioning

confidence: 99%

“…When defect sizes are large in other joints such as the knee, osteochondral auto- or allograft transfers have demonstrated good outcomes and return to activities and sports. 6 , 11 , 20 , 29 , 40 However, for OLTPs, only case reports thus far have described grafting. 8 , 38 Ueblacker et al 38 utilized retrograde autografts from the femoral trochlea for the osteochondral transfer plug in 2 patients with distal tibial lesions.…”

Section: Discussionmentioning

confidence: 99%

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Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

Allahabadi

Allala

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral lesions of the tibial plafond (OLTPs) remain less common than osteochondral lesions of the talus (OLTs), but recognition of the condition has increased. Purpose: To systematically evaluate the literature on lesion locations and treatment outcomes of OLTPs, whether in isolation or in combination with OLTs. Study Design: Systematic review; Level of evidence, 4. Methods: A search was performed using the PubMed, Embase, and CINAHL databases for studies on lesion locations or with imaging or treatment outcomes of OLTPs. Case reports and reports based on expert opinion were excluded. Lesion locations as well as outcome measure results were aggregated. The Methodological Index for Non-randomized Studies score was used to assess methodological quality when applicable. Results: Included in this review were 10 articles, all published in 2000 or later. Most studies were evidence level 4, and the mean Methodological Index for Non-randomized Studies score was 8.6 (range, 8-10). Overall, 174 confirmed OLTP cases were identified, and the mean patient age was 38.8 years. Of the 157 lesions with confirmed locations, the most common was central-medial (32/157; 20.4%). Of 6 studies on treatment outcomes, all but 1 evaluated bone marrow stimulation techniques. Microfracture of small lesions (<150 mm2) was the most common treatment utilized. Imaging and functional outcomes appeared favorable after treatment. The data did not support differences in outcomes between isolated OLTPs and OLTPs with coexisting OLTs. Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. Areas for future research include the following: the effect of patient factors and additional pathologies on outcomes; larger or deeper lesion treatment; more direct comparisons of outcomes between kissing or coexisting lesions and isolated lesions; and head-to-head comparison of treatments, such as microfracture, bone marrow–derived cell transplantation, and osteochondral autografts/allografts.

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Section: Discussionmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

Allahabadi

Allala

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Return to play after OCA in younger patients has been investigated previously with rates reported between 75% and 88%, and 38% to 80% returning at the previous or higher level of play. 18-20 Other studies that have investigated the performance of OCA transplantation in older patients have not included return to play statistics, suggesting the alternative goals of pain relief and ability to perform low-impact activities for this population. 13,14 However, as this patient population continues to seek to maintain high activity levels and with greater numbers of them participating in organized and regular team sports and athletics, return to play statistics remain critically relevant for this cohort.…”

Section: Discussionmentioning

confidence: 99%

High Return to Sport in Patients Over 45 Years of Age Undergoing Osteochondral Allograft Transplantation for Isolated Chondral Defects in the Knee

et al. 2021

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Objective: The purpose of this study was to evaluate the efficacy of osteochondral allograft (OCA) in patients older than 45 years of age, particularly with respect to return to sport. Design: A retrospective review was performed to evaluate patients greater than 45 who underwent an OCA for a symptomatic osteochondral defect of the knee between June 2011 and January 2019. Results: Overall, there were 18 patients (76% male) that met our inclusion and exclusion criteria. Follow-up was attained in 14 of these patients (78%). The mean age of patients included was 52.6 years (48-57) with a mean of 37 months of follow-up (18-60). Visual Analogue Scale scores decreased significantly from the preoperative baseline to final follow-up (7.7 ± 1.7 vs. 2.0 ± 2.0, P < 0.01). Furthermore, the mean Visual Analogue Scale while playing sport was 3.4 ± 3.2, and the mean Knee Injury and Osteoarthritis Outcome Score was 77.5 ± 12.7 at final follow-up. Overall, 11 patients (78.6%) were able to return to their desired sport. No clinical failures were identified during the follow-up period. Conclusion: In our series of patients 45 years and older who were treated with OCA for focal osteochondral injuries of the knee, we found a significant improvement in clinical outcome scores at a midterm follow-up of 37 months with no revision OCA procedures or conversion to any form of knee arthroplasty. In addition, a high percentage of patients were able to return to their preferred level of athletic activity.

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“…In all cases, range of motion is encouraged to prevent postoperative stiffness, as well as promote healing. 31…”

Section: Fixation Of Osteochondral Fragmentmentioning

confidence: 99%

Small Cartilage Defect Management

et al. 2020

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Cartilage defects in the knee are common resulting in significant pain and morbidity over time. These defects can arise in isolation or concurrently with other associated injuries to the knee. The treatment of small (< 2–3 cm2) cartilage deficiencies has changed as our basic science knowledge of tissue healing has improved. Advancements have led to the development of new and more effective treatment modalities. It is important to address any associated knee injuries and limb malalignment. Surgical options are considered when nonoperative treatment fails. The specific procedure depends on individual patient characteristics, lesion size, and location. Debridement/chondroplasty, microfracture, marrow stimulation plus techniques, fixation of unstable osteochondral fragments, osteochondral autograft transfer, and osteochondral allograft transplantation, all have roles in the treatment of small cartilage defects.

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Return-to-Play and Rehabilitation Protocols following Cartilage Restoration Procedures of the Knee: A Systematic Review

Cited by 34 publications

References 25 publications

Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

High Return to Sport in Patients Over 45 Years of Age Undergoing Osteochondral Allograft Transplantation for Isolated Chondral Defects in the Knee

Small Cartilage Defect Management

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