Return to Sport After Articular Cartilage Repair in Athletes’ Knees: A Systematic Review

Campbell, Andrew B.; Pineda, Miguel Bernad; Harris, Joshua D.; Flanigan, David C.

doi:10.1016/j.arthro.2015.08.028

Cited by 134 publications

(146 citation statements)

References 54 publications

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“…At a mean 59.9-month follow-up, the current study demonstrated that 60% of patients who had ACI for a symptomatic focal chondral defect of the knee were able to return to military duty and their occupational demands. This rate is slightly lower than previously reported success rates of 73% to 84% 3,9,11,17,21,22,25 but may be commensurate with the intense physical profile of this demographic and the limited time frame allotted for rehabilitation within the military framework.…”

Section: Discussioncontrasting

confidence: 57%

“…A systematic review by Campbell et al 3 reported on cartilage repair in the athlete’s knee. The authors sought to determine which surgical techniques returned athletes to competition and correlated patient- and defect-specific factors that were associated with successful return to sport.…”

Section: Discussionmentioning

confidence: 99%

“…This is in stark contrast to previous studies that have largely found that younger patient age is associated with superior outcomes. 3,17 Nawaz et al 17 reported on the mid- to long-term results of skeletally mature individuals undergoing ACI, with 78% and 51% graft survival at 5 and 10 years, respectively, and younger patients serving as the ideal candidates for ACI due to limited degeneration of adjacent compartments. In the current population, these disparate findings may reflect disproportionately greater physical demands associated with junior military status as well as the importance of peak physical fitness in career progression.…”

Section: Discussionmentioning

confidence: 99%

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Return to Preoperative Function After Autologous Cartilage Implantation of the Knee in Active Military Servicemembers

Zarkadis

Kusnezov

Garcia

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Autologous chondrocyte implantation (ACI) has been shown to provide adequate durability, pain relief, and improved long-term functional outcomes in the average patient, but proof of its efficacy in individuals with greater than average physical demands is scarce. Further knowledge is required to understand which patients may benefit from ACI and to identify which risk factors are associated with failure to return to the preinjury activity level.Purpose:To determine the occupational outcomes, rates of reoperation, and variables predictive of suboptimal outcomes after ACI.Study Design:Case series; Level of evidence, 4.Methods:All active-duty military servicemembers in the United States who underwent ACI of the knee between 2004 and 2014 were identified. Demographic information, injury characteristics, surgical variables, and clinical and surgical outcomes were extracted from the medical record. Univariate and multivariate analyses were used to determine significant independent predictors of clinical and surgical failures.Results:A total of 90 patients (91 knees) met the inclusion criteria. The cohort was predominantly male (86%), with a mean age of 34.5 ± 6.3 years (range, 20-50 years). The most common location of the articular cartilage lesion was the patellofemoral compartment (54 lesions, 59%), and the mean Outerbridge grade and size were 3.8 ± 0.4 and 4.00 ± 2.77 cm2 (range, 1.2-15.0 cm2), respectively. A total of 72 patients (79%) had at least 1 previous knee procedure. Nearly three-quarters of patients (71%) underwent concomitant procedures. At a mean follow-up of 59.9 ± 27.1 months (range, 24.0-140.1 months), 60% of our patients reported significant improvement in knee pain and did not require further surgical intervention. Multivariate analysis identified age <30 years as the only significant independent predictor of both clinical (P = .011) and overall failure (P = .014). Moderate-demand military occupational specialties (P = .036), exclusive involvement of the patellofemoral compartment (P = .045), and use of a periosteal patch (P = .0173) were additionally found to be independent predictors of surgical failure.Conclusion:Treatment of articular cartilage defects of the knee with ACI in physically active young individuals can return nearly two-thirds of individuals to daily activity with decreased pain and improved function. Risk factors for failure after ACI surgery were age younger than 30 years, lower demand occupation, exclusive involvement of the patellofemoral compartment, prior microfracture, and use of a periosteal patch.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Return to Preoperative Function After Autologous Cartilage Implantation of the Knee in Active Military Servicemembers

Zarkadis

Kusnezov

Garcia

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…A recent systematic review found both ACI and osteochondral autograft transplantations to have rates of return to sport exceeding 80%, both superior to microfracture. 10 Factors associated with increased sports participation included smaller defect size, younger age, shorter duration of symptoms, and no prior surgeries. While ACI has been demonstrated to consistently improve pain and functionality with daily activities and recreational sports, some studies have reported that return to high-level sports is unlikely.…”

Section: Discussionmentioning

confidence: 99%

Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

Pike

Bryant

Ogura

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects.Hypothesis:ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI.Study Design:Case series; Level of evidence, 4.Methods:Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures.Results:Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions.Conclusion:Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

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“…Other studies reinforce the notion that rigorous rehabilitation after ACI can improve the chances of a successful return to sport. 6,8 After ACL rupture, the prospect of eventual arthritic degeneration is also a long-term concern. In the latest installment in their ongoing analysis of ACL reconstruction with autogenous patellar tendon grafts, Shelbourne et al 26 examined the factors associated with the development of osteoarthritis in 398 patients (423 knees) who had undergone surgery 20 or more years previously.…”

mentioning

confidence: 99%

A Long Shot

Reider¹

2017

Am J Sports Med

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Return to Sport After Articular Cartilage Repair in Athletes’ Knees: A Systematic Review

Cited by 134 publications

References 54 publications

Return to Preoperative Function After Autologous Cartilage Implantation of the Knee in Active Military Servicemembers

Return to Preoperative Function After Autologous Cartilage Implantation of the Knee in Active Military Servicemembers

Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

A Long Shot

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