Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis

Aaron Krych, Ayoosh Pareek, Alexander H. King, Nick R. Johnson, Michael J. Stuart, Riley J. Williams

Research output: Contribution to journalReview article

36 Citations (Scopus)

Abstract

Purpose: Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques. Methods: A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model. Results: Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total, 2549 patients were included (1756 M, 793 F) with an average age of 35 years and follow-up of 47 months. Return to sport at some level was 76 % overall, with highest rates of return after OAT (93 %), followed by OCA (88 %), ACI (82 %), and MFX (58 %). Osteochondral autograft transfer showed the fastest return to sports (5.2 ± 1.8 months) compared to 9.1 ± 2.2 months for MFX, 9.6 ± 3.0 months for OCA and 11.8 ± 3.8 months for ACI (P < 0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport. Conclusion: In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76 % return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects. Level of evidence: IV.

Original languageEnglish (US)
Pages (from-to)3186-3196
Number of pages11
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume25
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Articular Cartilage
Meta-Analysis
Knee
Autografts
Athletes
Cartilage
Chondrocytes
Sports
Return to Sport
Stress Fractures
Autologous Transplantation
Allografts
Outcome Assessment (Health Care)

Keywords

  • Autologous chondrocyte implantation
  • Cartilage
  • Microfracture
  • Osteochondral allograft transplantation
  • Osteochondral autograft transfer
  • Return to sport

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Return to sport after the surgical management of articular cartilage lesions in the knee : a meta-analysis. / Krych, Aaron; Pareek, Ayoosh; King, Alexander H.; Johnson, Nick R.; Stuart, Michael J.; Williams, Riley J.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 25, No. 10, 01.10.2017, p. 3186-3196.

Research output: Contribution to journalReview article

Krych, Aaron ; Pareek, Ayoosh ; King, Alexander H. ; Johnson, Nick R. ; Stuart, Michael J. ; Williams, Riley J. / Return to sport after the surgical management of articular cartilage lesions in the knee : a meta-analysis. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2017 ; Vol. 25, No. 10. pp. 3186-3196.
@article{25d939552e00450692cc566478159c5c,
title = "Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis",
abstract = "Purpose: Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques. Methods: A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model. Results: Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total, 2549 patients were included (1756 M, 793 F) with an average age of 35 years and follow-up of 47 months. Return to sport at some level was 76 {\%} overall, with highest rates of return after OAT (93 {\%}), followed by OCA (88 {\%}), ACI (82 {\%}), and MFX (58 {\%}). Osteochondral autograft transfer showed the fastest return to sports (5.2 ± 1.8 months) compared to 9.1 ± 2.2 months for MFX, 9.6 ± 3.0 months for OCA and 11.8 ± 3.8 months for ACI (P < 0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport. Conclusion: In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76 {\%} return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects. Level of evidence: IV.",
keywords = "Autologous chondrocyte implantation, Cartilage, Microfracture, Osteochondral allograft transplantation, Osteochondral autograft transfer, Return to sport",
author = "Aaron Krych and Ayoosh Pareek and King, {Alexander H.} and Johnson, {Nick R.} and Stuart, {Michael J.} and Williams, {Riley J.}",
year = "2017",
month = "10",
day = "1",
doi = "10.1007/s00167-016-4262-3",
language = "English (US)",
volume = "25",
pages = "3186--3196",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer Verlag",
number = "10",

}

TY - JOUR

T1 - Return to sport after the surgical management of articular cartilage lesions in the knee

T2 - a meta-analysis

AU - Krych, Aaron

AU - Pareek, Ayoosh

AU - King, Alexander H.

AU - Johnson, Nick R.

AU - Stuart, Michael J.

AU - Williams, Riley J.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Purpose: Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques. Methods: A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model. Results: Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total, 2549 patients were included (1756 M, 793 F) with an average age of 35 years and follow-up of 47 months. Return to sport at some level was 76 % overall, with highest rates of return after OAT (93 %), followed by OCA (88 %), ACI (82 %), and MFX (58 %). Osteochondral autograft transfer showed the fastest return to sports (5.2 ± 1.8 months) compared to 9.1 ± 2.2 months for MFX, 9.6 ± 3.0 months for OCA and 11.8 ± 3.8 months for ACI (P < 0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport. Conclusion: In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76 % return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects. Level of evidence: IV.

AB - Purpose: Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques. Methods: A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model. Results: Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total, 2549 patients were included (1756 M, 793 F) with an average age of 35 years and follow-up of 47 months. Return to sport at some level was 76 % overall, with highest rates of return after OAT (93 %), followed by OCA (88 %), ACI (82 %), and MFX (58 %). Osteochondral autograft transfer showed the fastest return to sports (5.2 ± 1.8 months) compared to 9.1 ± 2.2 months for MFX, 9.6 ± 3.0 months for OCA and 11.8 ± 3.8 months for ACI (P < 0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport. Conclusion: In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76 % return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects. Level of evidence: IV.

KW - Autologous chondrocyte implantation

KW - Cartilage

KW - Microfracture

KW - Osteochondral allograft transplantation

KW - Osteochondral autograft transfer

KW - Return to sport

UR - http://www.scopus.com/inward/record.url?scp=84982243126&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982243126&partnerID=8YFLogxK

U2 - 10.1007/s00167-016-4262-3

DO - 10.1007/s00167-016-4262-3

M3 - Review article

C2 - 27539401

AN - SCOPUS:84982243126

VL - 25

SP - 3186

EP - 3196

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 10

ER -