A Randomized Trial Comparing Accelerated and Traditional Approaches to Postoperative Weightbearing Rehabilitation After Matrix-Induced Autologous Chondrocyte Implantation

Abstract

The outcomes of this randomized trial demonstrate a safe and effective accelerated rehabilitation protocol as well as a regimen that provides comparable, if not superior, clinical outcomes to patients throughout the postoperative timeline.

Cell Technologies and Tissue Engineering in the Treatmentof Articular Chondral Defects

“…Обычно нагрузку ограничивают 8 12 недель. В рандомизированном контроли руемом исследовании применения MACI ® по казана безопасность и потенциальное превос ходство ускоренной реабилитации (длитель ность 3 месяца, нагрузка на оперированную ко нечность через 8 недель) [39,55], однако, пока недостаточно исследований отдаленных ре зультатов. Возвращение к спортивной деятель ности после применения MACI ® возможно не ранее чем через 18 месяцев [5].…”

Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

“…55,56,61 Therefore, graduated weight-bearing and jointloading programs are important so that understimulation or overstimulation of the healing tissue at any stage of the postoperative timeline does not occur. In animal models, gradual introduction of forces to the repaired site is known to stimulate matrix production, improve tissue mechanical properties, facilitate synovial fluid flow, and stimulate metabolic activity for articular cartilage and bony healing.7,73 The present review identified 4 studies 14,15,17,18 that evaluated accelerated (full weight bearing by 8 weeks) and traditional (full weight bearing by 11 weeks) protocols post-ACI, which yielded similar gait characteristics at 3 months 18 and 1 year, 15 relatively similar functional outcomes at 2 and 5 years postprocedure, 14 and no significant differences over 5 years postprocedure in magnetic resonance imaging assessment of the morphological characteristics and signal intensity of the repair tissue.14 After tissue healing, adverse signs (increased effusion that may indicate joint overload, and strength/ activation deficits of the QF muscles and other dynamic stabilizers) may be useful objective criteria, rather than time-based criteria, for appropriate weight-bearing progression.Following knee surgical procedures, individuals with QF muscle weakness demonstrate altered knee biomechanics during gait 44 and reduced performance on single-limb hop tests 60 compared to individuals with strong QF muscles. These studies highlight the importance of QF strength in facilitating appropriate joint mechanics and optimizing performance.…”

“…40,47 Items with the highest average scores were for diagnostic certainty and outcome criteria (description of outcome measures, timing of assessment, and use of outcomes with good reliability and sensitivity). Items with lower average item scores were for type of study and procedure of outcome assessment.In terms of lesion location, 6 studies 19,24,39,40,47,59 included participants with lesions in the tibiofemoral (medial/ lateral femoral condyle, tibial plateau)With cartilage terms plus English language/humans filter (searches 1 and 2), n = 7326 Initial search (with variables of interest, searches 4, 5, 6, 7 and removed duplicates), n = 2612 • Outcomes related to muscle performance (search 4), n = 421 • Outcomes related to biomechanics/joint loading (search 5), n = 401 • Outcomes related to performance-based function (search 6), n = 1403 • Outcomes related to rehabilitation protocols (search 7), n = 387Excluded based on animal and cadaver studies (not found by filter), cartilage defects in other joints (not the knee), concomitant or additional surgeries performed with cartilage procedure, n = 762Excluded based on patient population of interest (eg, osteoarthritis, pediatric); outcome measures not related to performance-based measures (eg, patient-reported outcomes only); outcomes pertaining to histology, imaging, or surgery (eg, adverse events); or surgical-technique studies, n = 1834 and patellofemoral (patella, trochlea) compartments, and 10 studies [12][13][14][15][16][17][18]20,68,69 included only those with lesions in the tibiofemoral compartments (medial/ lateral condyle, tibial plateau). Of the 16 included studies, 3 evaluated outcomes following MF techniques 24,68,69 and 15 studies [12][13][14][15][16][17][18][19][20]39,40,…”

“…Of the 16 included studies, 3 evaluated outcomes following MF techniques 24,68,69 and 15 studies [12][13][14][15][16][17][18][19][20]39,40,47,59,68,69 evaluated outcomes following chondrocyte implantation techniques. Preoperative data were reported in 6 studies, 13,14,17,59,68,69 and postoperative follow-ups ranged from 3 months to 7.4 years postprocedure. Across both MF and ACI procedures, 7 studies provided data on muscle performance, 16,18,20,39,40,47,68 3 studies from the same group provided data on knee biomechanics and joint loading, 12,15,18 and 10 studies reported on performance-based functional outcomes.…”

“…Portions of the results of these studies are discussed above in the outcomes section, but are further summarized here to emphasize comparisons between the different rehabilitation pro- grams. Ebert and colleagues 14,15,17,18 conducted an RCT of accelerated (full weight bearing by 8 weeks) or traditional (full weight bearing by 11 weeks) rehabilitation programs following ACI with 3-, 6-, 12-, and 24-month and 5-year follow-up measures of function (TABLE 4, available online) 14,17,18 and knee mechanics during gait (TABLE 3, available online). 15,18 Specifically, the accelerated rehabilitation protocol consisted of a 2-week period of weight bearing at 20% body weight, with a progressive increase to full weight bearing by 8 weeks.…”