Post-Operative Sport Participation and Satisfaction With Return to Activity After Matrix-Induced Autologous Chondrocyte Implantation in the Knee

Abstract

Background: Returning to a satisfactory activity level is expected by patients after cartilage repair, and may define overall surgical success.Purpose: To investigate: 1) the level and improvement in activity in patients at two years after matrix-induced autologous chondrocyte implantation (MACI), 2) what factors are associated with post-operative (and improvement in) activity level, and 3) whether patients are satisfied with their ability to participate in recreational and/or sporting activities. Study Design: Prospective cohort.Methods: One hundred and fifty patients that underwent MACI were included in this analysis (83 tibiofemoral and 67 patellofemoral). All patients completed the Tegner Activity Scale (TAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) presurgery and at two years (range: 24-26 months) post-surgery, as well as a questionnaire evaluating satisfaction with their ability to return to recreational and sporting activities. Results:The TAS significantly improved (p<0.001) from 2.97 (SD 0.92, range 0-7) to 4.09 (SD 1.49, range 0-9), while the KOOS Sport significantly improved (p<0.0001) from 27.5 (SD 23.1, range 0-95) to 61.1 (SD 27.3, range 0-100). Overall, 88 patients (59%) improved ≥1 point on the TAS, while 121 patients (81%) improved ≥10 points on the KOOS Sport, previously reported as the minimal detectable change for each. Patient age, duration of symptoms (DOS) and gender were associated with post-operative activity level, though body mass index (BMI), defect size and concomitant procedures were not. Overall, 128 patients (85%) were satisfied with their ability to return to recreational activities, with 99 (66%) satisfied with sport participation. The two-year TAS, and TAS improvement, were significantly associated with satisfaction in performing recreational activities (two-year TAS, rho=-0.42, p<0.0001; TAS improvement, r=-0.33, p<0.0001) and sport participation (two-year TAS, rho=-0.49, p<0.0001; TAS improvement, r=-0.37, p<0.0001). Conclusions:The TAS and KOOS Sport significantly improved after MACI, though only 59% of patients improved ≥1 point on the TAS. Despite this, 85% and 66% of patients were satisfied with their ability to return to recreational activities and participate in sport, respectively. Age, DOS and gender were associated with activity, and overall these findings can be used to provide realistic activity expectations to patients undergoing MACI.

Autologous chondrocyte implantation for treatment of articular cartilage defects in the knee and ankle of football (soccer) players

“…It has been shown that addressing simultaneously both, cartilage lesion and concomitant injury, does not negatively affect the return-to-play rate. 85 In the presence of a concomitant meniscus tear it is crucial to suture and refixate the tissue where possible, as a partial or full meniscectomy is known to be a contributor to progression of osteoarthritis and negatively affects the healing potential of the cartilage lesion. 3 While a debridement of a meniscus lesion might lead to an earlier RTP, its mid-and long-term effects are less favorable and should therefore be avoided if possible.…”

Management of Articular Cartilage Defects in the Knee: An Evidence-Based Algorithm

“…ACI is indicated for larger, grade 3 to 4 lesions, yielding significant improvements for patients with lesions as large as 14 cm 2 and 12 mm deep into subchondral bone 2 . Significant improvements in function and pain following ACI are evident at short-term (85% return to recreational activities, 66% return to sport at 2 years) and long-term follow-up (stable clinical improvements with a 10% failure rate at 11 years) 39,40 . However, patient expectations must be managed as ACI requires 2 surgeries and 6 weeks non–weight-bearing postoperatively 2 .…”

The Team Physician: Return to Play Considerations and Outcomes

“…2). In a prospective cohort study of 150 patients who underwent matrix-induced autologous chondrocyte implantation with 2-year follow-up, 85% and 66% of patients were satisfied with their ability to return to recreational activities and sports, respectively 49. In a separate study of 97 patients with interval follow-up at 1, 2, and 5 years, satisfaction with sports was achieved in 55.7%, 73.2%, and 68.5% of patients, respectively 50.…”