Returning to Work After Articular Cartilage Repair Intervention: A Systematic Review

Abstract

Background: The process of returning to work after cartilage treatment has not been studied in depth, even though a better understanding of potential outcomes could lead to significant benefits for the general population. Purpose: To determine which surgical interventions are most effective in helping patients return to work after cartilage repair and to identify factors that affect the ability to return to work. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in analyzing reports on articular cartilage treatment and return to work published from January 1966 (when the first system of classifying articular cartilage injuries based on the mechanism of injuries and type of lesions was developed) to January 2019. General surgical information and available clinical scores were used to assess outcomes. Results: Only 5 studies describing 283 patients were found to be relevant to our objectives and were therefore included in the analysis. Autologous chondrocyte implantation (ACI) and osteochondral allografts were the only 2 procedures for which information was included regarding patient return to work rates. The mean (overall) return-to-work time after a cartilage repair operation was 4.80 ± 3.02 months. ACI was the most common procedure (3 studies; 227 patients). Return to work after ACI or ACI with high tibial osteotomy (HTO) occurred in almost 100% of cases, whereas the rate of return to work was 51.78% for patients who underwent osteochondral allograft ( P < .01); further, patients who had ACI or ACI+HTO returned to work sooner compared with patients who underwent osteochondral allograft. The Knee injury and Osteoarthritis Outcome Score (KOOS) and Single Assessment Numerical Evaluation (SANE) scores were significantly higher in patients who fully returned to work. No significant difference was found in rates of return to work after ACI related to sex, area of the lesion, or size of the defect. Conclusion: The vast majority of published results on articular cartilage repair do not include data on return to work. Although available data on articular cartilage repair in the general population reveal a high rate of return to work, including those patients treated with ACI, the data do not stratify patients by the type and demand of work. No randomized studies have examined return-to-work rates. Hence, authors should include these data in future studies. A refined definition of work intensity, rather than just return to work, may provide a clearer picture of the relative effectiveness of different surgical interventions. To that end, the authors propose a return to work prognostic score called the Prognostic Cartilage Repair Return to Work Score, or PROCART-RTW score.

Comparison of Clinical Outcome following Cartilage Repair for Patients with Underlying Varus Deformity with or without Additional High Tibial Osteotomy: A Propensity Score–Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU)

“…A recent systematic review depicted almost 100% return to work rates after ACI plus HTO whereas a significantly less number of patients (51.78%) returned to their former work activity after osteochondral allograft transplantation. 22 HTO in combination with ACI also led to the shortest return to work time (3.15 months) compared to ACI alone (3.34 months) and osteochondral allograft (11.1 months). Multiple studies and even systematic reviews and meta-analyses on the effect of high tibial osteotomy with a concomitant "cartilage procedure" in osteoarthritic knees compared with HTO alone exist, 11,[23][24][25][26][27] but literature about cartilage procedures with versus without concomitant high tibial osteotomy in patients with focal cartilage defects is sparse.…”

Consensus on Rehabilitation Guidelines among Orthopedic Surgeons in the United States following Use of Third-Generation Articular Cartilage Repair (MACI) for Treatment of Knee Cartilage Lesions

“…There are few studies of the timing of return to ADL and/or work following ACI/MACI published in the literature, and there is limited information for the type and demand of the work. 28 Therefore, obtaining consensus on these milestones was important so that realistic expectations for patients and surgeon guidance can be established for MACI. One case series study by Pestka et al .…”

Are cartilage repair and restoration procedures in the knee without respecting alignment fruitless? A comprehensive review

“…Based on the German Cartilage Registry, Faber et al 83 reported that concomitant osteotomy results in better postoperative KOOS values, lower pain levels, and a higher patient satisfaction when combined with cartilage repair. The systematic review of 2020 by Nimkingratana et al 90 concluded that when osteotomy was associated with cartilage procedures, increased rates of repairs and shorter periods to return to work were seen. For focal cartilage defects, osteotomy could therefore act as a solid foundation for the reconstruction of the lesion.…”