High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis

Abstract

BackgroundKnee osteotomies are proven treatment options, especially in younger patients with unicompartmental knee osteoarthritis, for certain cases of chronic knee instability, or as concomitant treatment for meniscal repair or transplantation surgery. Presumably, these patients wish to stay active. Data on whether these patients return to sport (RTS) activities and return to work (RTW) are scarce.ObjectivesOur aim was to systematically review (1) the extent to which patients can RTS and RTW after knee osteotomy and (2) the time to RTS and RTW.MethodsWe systematically searched the MEDLINE and Embase databases. Two authors screened and extracted data, including patient demographics, surgical technique, pre- and postoperative sports and work activities, and confounding factors. Two authors assessed methodological quality. Data on pre- and postoperative participation in sports and work were pooled.ResultsWe included 26 studies, involving 1321 patients (69% male). Mean age varied between 27 and 62 years, and mean follow-up was 4.8 years. The overall risk of bias was low in seven studies, moderate in ten studies, and high in nine studies. RTS was reported in 18 studies and mean RTS was 85%. Reported RTS in studies with a low risk of bias was 82%. No studies reported time to RTS. RTW was reported in 14 studies; mean RTW was 85%. Reported RTW in studies with a low risk of bias was 80%. Time to RTW varied from 10 to 22 weeks. Lastly, only 15 studies adjusted for confounders.ConclusionEight out of ten patients returned to sport and work after knee osteotomy. No data were available on time to RTS. A trend toward performing lower-impact sports was observed. Time to RTW varied from 10 to 22 weeks, and almost all patients returned to the same or a higher workload.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-017-0726-y) contains supplementary material, which is available to authorized users.

Realignment osteotomy of the knee allows for return to work and sport activities in the young athletic population

“…The procedure provides both an offloading component as well as a more favourable mechanical environment in the presence of ligament laxity. In our young patient cohort, the return to work rate was 93%, which is comparable with the highest reported rates in the literature 32. Evidence on the possibility of returning to professional or competitive levels of sports following knee osteotomy is sparse.…”

Integrated care programmes for sport and work participation, performance of physical activities and quality of life among orthopaedic surgery patients: a systematic review with meta-analysis

“…This is remarkable given the importance of participation in sports and work for patients after orthopaedic surgery,5 6 especially for patients who are of working age for whom resumption of societal participation is an important treatment goal. Moreover, return to sports and work is typically delayed and/or not successful for many of these patients 7–11. For instance, patients undergoing joint replacement surgery considered advice regarding participation to be inconsistent and not tailored to their individual circumstances, which often left them with the feeling that they would have been able to recover sooner than what they had actually accomplished 5…”

Return to Sport and Outcomes After Concomitant Lateral Meniscal Allograft Transplant and Distal Femoral Varus Osteotomy

“…The current literature on the topic of RTS for patients receiving isolated correctional osteotomies of the knee has included heterogeneous populations, mostly focusing on patients receiving valgus-inducing osteotomies. 13 To our knowledge, only 1 previous study has analyzed physical activity after DFVO for lateral compartment knee OA. De Carvalho et al 38 reported on 26 patients who received a DFVO at 48 months' follow-up, only 15 (57.7%) of whom had performed routine physical activity preoperatively.…”

“…11,12 Recent improvements in operative techniques, surgical devices, and evidence-based treatment guidelines have allowed for realignment procedures and MAT to be performed in combination. 13 Previous studies have shown that MAT and realignment osteotomies, when performed in combination, provide clinically meaningful patient improvements at short-and long-term follow-up. 5,14 However, these studies are heterogeneous in terms of indications and techniques because they included patients with either medial or lateral compartment pathology due to valgus or varus malalignment.…”