Abstract
PurposeThe purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures.MethodsA search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention.ResultsThere were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%).ConclusionsHigh rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level.Level of evidenceIV
Highlights
Chondral defects in the knee are problematic for athletes primarily as a consequence of 1) focal defects having intrinsically a poor ability to heal and 2) the early development of symptomatic arthritis
Sporting participation following microfracture was 64.2%, matrix-induced autologous chondrocyte implantation (MACI) was 74.0%, autologous chondrocyte implantation (ACI) was 80.7%, Osteochondral allograft was 83.9%, osteochondral autograft transfer (OAT) was 84.4%, and platelet rich plasma (PRP) and peripheral blood stem cells (PBSC) was 100% (p < 0.001)
There is a high rate of sustained return to sport observed following surgery, with relatively worse outcomes for those who have undergone microfracture compared to other modes of intervention
Summary
Chondral defects in the knee are problematic for athletes primarily as a consequence of 1) focal defects having intrinsically a poor ability to heal and 2) the early development of symptomatic arthritis. These injuries are reported to be 20% more common in athletes compared to the general population [2] and can lead to lifestyle modification (such as ceasing sporting participation) due to pain and loss of function. It is imperative that tailored and effective treatment options are offered to these patients Such treatments will preserve the integrity of the native knee and return the patient to their pre-injury performance level within an acceptable timeframe. Chondral injury has been reported to present in up to 50% of patients undergoing ACL reconstructive surgery [4, 6]
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