Functional Outcome of Knee Articular Cartilage Repair in Adolescent Athletes

Mithöfer, Kai; Minas, Tom; Peterson, Lars; Yeon, Howard B.; Micheli, Lyle J.

doi:10.1177/0363546504274146

Cited by 158 publications

(176 citation statements)

References 33 publications

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“…2) indicating a possible link between OCD etiology and better outcomes, although this association could be due to the confounding effect of age because patients with OCD tend to be younger. These results are consistent with previous studies that have reported greater improvements in younger patients [15][16][17][18]. There are few studies examining the effect of age on results from ACI, in spite of the fact that it appears to be an important variable in determining results.…”

Section: Discussionsupporting

confidence: 91%

Spanish Experience in Autologous Chondrocyte Implantation

Cachafeiro¹

2010

TOORTHJ

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Introduction:The Spanish Ministry of Health commissioned the Galician Agency for Health Technology Assessment to monitor and follow-up Autologous Chondrocyte Implantation (ACI) used to treat chondral lesions of the knee in Spain. The objective of this monitoring was to assess efficacy and safety of the technique.Design: One-hundred and eleven consecutive patients with knee chondral lesions were included in a multi-center study between January 2001 and January 2005. ACI was used in these patients as a second-line treatment option (or a first-line treatment option if the cause was Osteocondritis dissecans). The Cincinnati score and the Short Form 36 (SF-36) questionnaire were used to assess the patients' self-reported satisfaction with the outcomes of ACI. A descriptive analysis was performed and non-parametric tests were used to establish correlations and compare results among subgroups. A multivariate analysis was also performed to measure the effect of different variables on changes in the condition of the knee.Results: Eighty men (72%) and 31 women (21%) with an age range from 16 to 49 years, underwent ACI surgery. Among these subjects, the most common previous first-line treatment was debridement (64 individuals, 74.4%). The mean size of the lesion treated with ACI was 3.82 cm 2 , and the most frequent location of the lesion was the inner femoral condyle (53.6%). The patient satisfaction was high or very high in 36 subjects (66.7%). Overall knee joint assessment improved from 4.32 points to 6.78. All SF-36 questionnaire categories improved, notably those related to physical condition. Conclusions:The results of this study indicate that ACI is safe; however, further studies are mandated to assess the efficacy of ACI compared to alternative treatment options.

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Section: Discussionsupporting

confidence: 91%

Spanish Experience in Autologous Chondrocyte Implantation

Cachafeiro¹

2010

TOORTHJ

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“…150 Several prospective studies have shown the ability to return to sport in 33% to 96% of athletes after ACI, with 60% to 80% of them returning to the same skill level. 119,121,122 Irrespective of the technique used for cartilage repair, the rate for return to sports was higher for younger and more competitive athletes with preoperative duration of symptoms of less than 1 year (TABLE 1). 64 Microfracture and OATS were effective primarily in athletes with smaller lesions, while the ability to return to sport after chondrocyte transplantation was independent of lesion size.…”

Section: Return To Sport After Knee Articular Cartilage Repairmentioning

confidence: 99%

Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete

Mithoefer¹,

Hambly²,

Logerstedt³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

106

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Synopsis Articular cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant acute and chronic joint stress associated with impact sports. Left untreated, articular cartilage defects can lead to chronic joint degeneration and athletic and functional disability. Treatment of articular cartilage defects in the athletic population presents a therapeutic challenge due to the high mechanical demands of athletic activity. Several articular cartilage repair techniques have been shown to successfully restore articular cartilage surfaces and allow athletes to return to high-impact sports. Postoperative rehabilitation is a critical component of the treatment process for athletic articular cartilage injury and should take into consideration the biology of the cartilage repair technique, cartilage defect characteristics, and each athlete's sport-specific demands to optimize functional outcome. Systematic, stepwise rehabilitation with criteria-based progression is recommended for an individualized rehabilitation of each athlete not only to achieve initial return to sport at the preinjury level but also to continue sports participation and reduce risk for reinjury or joint degeneration under the high mechanical demands of athletic activity. J Orthop Sports Phys Ther 2012;42(3):254–273. doi:10.2519/jospt.2012.3665

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“…During the surgical repair procedure, the debrided cartilage lesion is covered with a periosteal patch and the cultured chondrocytes are injected under the periosteal cover. This method has been tested in animal experiments [Brittberg et al, 1996;Breinan et al, 1997;Litzke et al, 2004;Vasara et al, 2004;Chiang et al, 2005] and is now in rather widespread use to repair cartilage defects in humans [Brittberg et al, 1994;Peterson et al, 2000;Mithöfer et al, 2005]. Clinical studies have reported a slow maturation of the repair tissue, but at present there is inadequate information about the quality of the collagen network within the repair zone [Vasara et al, 2005].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Analysis of Collagen Network Structure and Fibril Dimensions in Cartilage Repair with Autologous Chondrocyte Transplantation

Långsjö

Vasara

Hyttinen

et al. 2010

Cells Tissues Organs

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Objective: The aim of this study was to undertake a stereological analysis to quantify the dimensions of the collagen network in the repair tissue of porcine joints after they had been subjected to autologous chondrocyte transplantation (ACT). Method: ACT was used to repair cartilage lesions in knee joints of pigs. Electron-microscopic stereology, immunostaining for type II collagen, and quantitative polarized-light microscopy were utilized to study the collagen fibrils in the repair tissue 3 and 12 months after the operation. Results: The collagen volume density (V_V) was lower in the repair tissue than in normal cartilage at 3 months (20.4 vs. 23.7%) after the operation. The collagen surface density (S_V, 1.5·10^–2 vs. 3.1·10^–2 nm²/nm³) and V_V increased with time in the repair tissue (20.4 vs. 44.7%). Quantitative polarized-light microscopy detected a higher degree of collagen parallelism in the repair tissue at 3 months after the operation (55.7 vs. 49.7%). In contrast, 1 year after the operation, fibril parallelism was lower in the repair tissue than in the control cartilage (47.5 vs. 69.8%). Conclusion: Following ACT, V_V and S_V increased in the repair tissue with time, reflecting maturation of the tissue. One year after the operation, there was a lower level of fibril organization in the repair tissue than in the control cartilage. Thus, the newly synthesized collagen fibrils in the repair tissue appeared to form a denser network than in the control cartilage, but the fibrils remained more randomly oriented.

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Functional Outcome of Knee Articular Cartilage Repair in Adolescent Athletes

Cited by 158 publications

References 33 publications

Spanish Experience in Autologous Chondrocyte Implantation

Spanish Experience in Autologous Chondrocyte Implantation

Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete

Quantitative Analysis of Collagen Network Structure and Fibril Dimensions in Cartilage Repair with Autologous Chondrocyte Transplantation

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