Cartilage injuries often occur during sports activities, and return to sports after cartilage surgery is an important outcome parameter for different treatment methods in the competitive as well as the recreationally active population.
Hypothesis:
At the time of midterm follow-up after matrix-associated autologous chondrocyte transplantation (MACT), return to recreational sports at the preinjury level will be possible.
Study Design:
Case series; Level of evidence, 4.
Methods:
Seventy patients (51 men, 19 women; age [mean ± standard deviation], 34.9 ± 8.6 y; range, 18-55 y) were clinically evaluated 5 years after MACT through subjective clinical scores such as the Knee Injury and Osteoarthritis Outcome Score (KOOS) sport and recreation subscales, the Tegner activity scale, and the Noyes sports activity rating scale. The level of sports participation was included in the investigation.
Results:
The results 5 years after MACT showed mean values of 60.1 for the KOOS–sport, 67.4 for the Noyes, and 3.8 for the Tegner scores, meaning that regular sports activity such as cycling or running on flat ground, as well as medium-level manual labor, is possible. We noted that 74.3% of our patients returned to at least their preinjury sports level.
Conclusion:
Midterm postoperative results after MACT show that in a moderately active population, participation in regular sports is possible for most patients, at least at their preinjury recreational level and intensity, and there is a good rate of return to sports.
BehrensPBoschUBrunsJ. Indications and implementation of recommendations of the working group “Tissue Regeneration and Tissue Substitutes” for autologous chondrocyte transplantation (ACT). Z Orthop Ihre Grenzgeb. 2004;142(5):529-539.
2.
BlevinsFTSteadmanJRRodrigoJJSillimanJ. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics. 1998;21(7):761-767; discussion 767-768.
3.
BrittbergMLindahlANilssonAOhlssonCIsakssonOPetersonL. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331(14):889-895.
4.
BuckwalterJA. Articular cartilage: injuries and potential for healing. J Orthop Sports Phys Ther. 1998;28(4):192-202.
5.
CurlWWKromeJGordonESRushingJSmithBPPoehlingGG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456-460.
6.
Della VillaSKonEFilardoG. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes?Am J Sports Med. 2010;38(1):68-77.
7.
EbertJRRobertsonWBWoodhouseJ. Clinical and magnetic resonance imaging-based outcomes to 5 years after matrix-induced autologous chondrocyte implantation to address articular cartilage defects in the knee. Am J Sports Med. 2011;39(4):753-763.
8.
FlaniganDCHarrisJDTrinhTQSistonRABrophyRH. Prevalence of chondral defects in athletes’ knees: a systematic review. Med Sci Sports Exerc. 2010;42(10):1795-1801.
9.
GobbiANunagPMalinowskiK. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. 2005;13(3):213-221.
10.
HamblyK. The use of the Tegner Activity Scale for articular cartilage repair of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):604-614.
11.
HamblyKBobicVWondraschBVan AsscheDMarlovitsS. Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. Am J Sports Med. 2006;34(6):1020-1038.
12.
HangodyLKishGKarpatiZUdvarhelyiISzigetiIBelyM. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics. 1998;21(7):751-756.
13.
HarrisJDBrophyRHSistonRAFlaniganDC. Treatment of chondral defects in the athlete’s knee. Arthroscopy. 2010;26(6):841-852.
14.
HughesRJHoulihan-BurneDG. Clinical and MRI considerations in sports-related knee joint cartilage injury and cartilage repair. Semin Musculoskelet Radiol. 2011;15(1):69-88.
15.
KnutsenGEngebretsenLLudvigsenTC. Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am. 2004;86(3):455-464.
16.
KreuzPCSteinwachsMErggeletC. Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year follow-up. Am J Sports Med. 2007;35(8):1261-1268.
17.
MarlovitsSSingerPZellerPMandlIHallerJTrattnigS. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol. 2006;57(1):16-23.
MicheliLCurtisCShervinN. Articular cartilage repair in the adolescent athlete: is autologous chondrocyte implantation the answer?Clin J Sport Med. 2006;16(6):465-470.
20.
MithoeferKHamblyKDella VillaSSilversHMandelbaumBR. Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med. 2009;37(suppl 1):167S-176S.
21.
MithoeferKMcAdamsTRScoppJMMandelbaumBR. Emerging options for treatment of articular cartilage injury in the athlete. Clin Sports Med. 2009;28(1):25-40.
22.
MithoferKMinasTPetersonLYeonHMicheliLJ. Functional outcome of knee articular cartilage repair in adolescent athletes. Am J Sports Med. 2005;33(8):1147-1153.
23.
MithoferKPetersonLMandelbaumBRMinasT. Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. Am J Sports Med. 2005;33(11):1639-1646.
24.
NoyesFRBarberSDMooarLA. A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop Relat Res. 1989;246:238-249.
25.
PetersonLVasiliadisHSBrittbergMLindahlA. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38(6):1117-1124.
26.
RoosEMRoosHPLohmanderLSEkdahlCBeynnonBD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88-96.
27.
RotterudJHSivertsenEAForssbladMEngebretsenLAroenA. Effect of gender and sports on the risk of full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees: a nationwide cohort study from Sweden and Norway of 15,783 patients. Am J Sports Med. 2011;39(7):1387-1394.
28.
SteadmanJRRodkeyWGRodrigoJJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001(391 suppl):S362-369.
29.
TakedaHNakagawaTNakamuraKEngebretsenL. Prevention and management of knee osteoarthritis and knee cartilage injury in sports. Br J Sports Med. 2011;45(4):304-309.
30.
TegnerYLysholmJ. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43-49.
31.
Van AsscheDVan CaspelDVanlauweJ. Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up. Am J Sports Med. 2009;37(suppl 1):42S-49S.
32.
WelschGHMamischTCHughesTDomayerSMarlovitsSTrattnigS. Advanced morphological and biochemical magnetic resonance imaging of cartilage repair procedures in the knee joint at 3 Tesla. Semin Musculoskelet Radiol. 2008;12(3):196-211.
33.
WondraschBZakLWelschGHMarlovitsS. Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle on radiographic and clinical outcome after 2 years: a prospective, randomized controlled pilot study. Am J Sports Med. 2009;37(suppl 1):88S-96S.
