Mithoefer K, Hambly K, Della Villa S,
Silvers H, Mandelbaum B. American Journal of Sports Medicine; 2009, 37, 167 –
176.
Knee articular cartilage injury is a common
complaint among those participating in sport, both recreationally and as
professionals. Rarely occurs in isolation, most often is associated with other
injuries e.g. ACL tear, meniscal lesion.
Sports medicine physician are aware that repaired cartilage requires enough
quality to withstand significant stresses related with high impact sports.
Current cartilage repair techniques (microfracture, osteochondral autograft
transfer, osteochondral allograft transplantation and autologous chondrocyte
transplantation) are successful in reducing pain and improving knee function.
Nevertheless, ability to return to sports activity is the most important
outcome measure for the injured athlete. Mithoefer et al. systematically
reviewed available literature on return to sports activity following knee
cartilage repair and tried to determine influencing factors.
Twenty studies met the inclusion criteria
and were included in the systematic review. Average follow – up period was 42
months. Results indicated that return to sports participation was possible in
73% overall, with highest return rates following osteochondral autograft
transplantation. Time to return to sports activity varied between surgical
techniques, ranging from 7 (microfracture) to 18 months (autologous chondrocyte
transplantation) on average. Sport activity level prior to injury was possible
only in 65% of athletes with best durability seen after autologous chondrocyte
transplantation. Return to sport was influenced by several factors. Younger age
resulted in better rates of return to sports participation for all surgical
techniques. Another significant factor was time between diagnosis and surgery.
Athletes undergoing surgical treatment within 12 months after injury returned
to sport in 66 % (microfracture) and 67%
(ACT) of cases whereas those receiving treatment after a year of being
symptomatic, returned to sport in 14% and 15% of cases respectively. Better
clinical effects were reported in acute lesions, compared to chronic lesions,
especially to those with degenerative joint changes. Lesions smaller than 2 cm²
were associated with higher return rates for microfracture and osteochondral
autograft transfer. The type of cartilage injury had also influence, with
better outcomes seen after chondral defect rather than osteochondral defects. One
study reported lesions location as significant factor affecting return to
sports ability. Return to sports was significantly better in competitive
athletes than recreational athletes after microfracture and chondrocyte
transplantation, but no difference was observed with osteochondral autograft
transfer.
Authors concluded that current articular
cartilage repair techniques improve activity levels even under high mechanical stresses
and therefore are successful treatment options for injured athletes wishing to
return to sports participation. Highest return rates were observed after osteochondral autograft transfer which could be explained
with that this is a minimally invasive technique, is used to treat smaller defects, has a short
postoperative rehabilitation, and does not require generation of cartilage repair
tissue. Some studies reported decrease in activity level scores over the years,
and according to authors, this could be attributed to limited cartilage fill
volume and poor cartilage morphology (microfracture procedure), limited defect fill from settling of the transferred
cylinder, incomplete peripheral repair cartilage integration, relative thinning
of the repair cartilage owing to donor-recipient mismatch, and subchondral
sclerosis (osteochondral transfer) as well as to socioeconomic and psychological
factors, such as the fear of reinjury or family obligations. Finally, authors
summarize that younger competitive players with small defect size, short
duration of symptoms, and fewer prior surgical interventions have a higher probability
to return to sports.
All rights reserved to the American Journal of Sports Medicine.
All rights reserved to the American Journal of Sports Medicine.
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