Articular Cartilage Repair in athletes.

Abstract Articular Cartilage lesions in the athletic population commonly occur and result from the significant acute and chronic joint stress associated with high-impact sports. These lesions have poor intrinsic healing capacity, and the persistent defects in the joint surfaces cause pain, swelling, and mechanical symptoms that result in functional impairment and limitation of athletic participation. If untreated, Articular Cartilage lesions can lead to chronic joint degeneration and disability. Several techniques for Articular Cartilage Repair have been recently developed with promising results. However, the significant joint stresses generated in athletes require an effective and durable Cartilage surface restoration that can withstand the high mechanical demands in this population over time.

return to sports participation after Articular Cartilage Repair in the knee scientific evidence

BACKGROUND: Articular Cartilage injury in the athlete’s knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after Articular Cartilage Repair in the knee. HYPOTHESIS: Systematic analysis of athletic participation after Articular Cartilage Repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with Articular Cartilage injury of the knee. STUDY DESIGN: Systematic review. METHODS: A comprehensive literature review of original studies was performed to provide information about athletic participation after Articular Cartilage Repair. The athlete’s ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. RESULTS: Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the Cartilage Repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete’s age, preoperative duration of symptoms, level of play, lesion size, and Repair tissue morphology. CONCLUSION: Articular Cartilage Repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete’s postoperative expectations.

clinical efficacy of the microfracture technique for Articular Cartilage Repair in the knee an evidence based systematic analysis

BackgroundDespite the popularity of microfracture as a first-line treatment for Articular Cartilage defects in the knee, systematic information on its clinical efficacy for Articular Cartilage Repair and long-term improvement of knee function is not available.HypothesisSystematic analysis of the existing clinical literature of microfracture in the knee can improve the understanding of the advantages and limitations of this Cartilage Repair technique and can help to optimize its indications and clinical outcomes.Study DesignSystematic review.MethodsA comprehensive literature search was performed using established search engines (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials) to identify original human studies of Articular Cartilage Repair with microfracture. Modified Coleman Methodology Scores were used to analyze the quality of the existing studies. Clinical efficacy of Articular Cartilage Repair was evaluated by systematic analysis of short- and long-term functional outcome scor…

Articular Cartilage Repair in athletes.

Abstract Articular Cartilage lesions in the athletic population commonly occur and result from the significant acute and chronic joint stress associated with high-impact sports. These lesions have poor intrinsic healing capacity, and the persistent defects in the joint surfaces cause pain, swelling, and mechanical symptoms that result in functional impairment and limitation of athletic participation. If untreated, Articular Cartilage lesions can lead to chronic joint degeneration and disability. Several techniques for Articular Cartilage Repair have been recently developed with promising results. However, the significant joint stresses generated in athletes require an effective and durable Cartilage surface restoration that can withstand the high mechanical demands in this population over time.

current concepts for rehabilitation and return to sport after knee Articular Cartilage Repair in the athlete

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 prog…

return to sports after Articular Cartilage Repair in the football soccer player

Background: The ability to return to football (soccer) presents a critical aspect for successful treatment of Articular Cartilage injury in the football (soccer) player. Methods: Information about sports participation after Articular Cartilage Repair was collected from the literature. Special focus was placed on data in football athletes with information on return rate, timing of return, level of postoperative competition, and the ability to compete in the sport over time. Results: Twenty studies describing 1,469 athletes including football players with Articular Cartilage injury were reviewed. Average return to sport was 79% without a significant difference in return rate or postoperative level of play between Cartilage Repair techniques. Time to return varied between 7 to 17 months, with the longest time for autologous chondrocyte transplantation (ACI). Advanced sport-specific rehabilitation was able to reduce recovery time. Durability of results was best after ACI, with up to 96% continued sport partic…

a vision on the future of Articular Cartilage Repair

: An AO Foundation (Davos, Switzerland) sponsored workshop “Cell Therapy in Cartilage Repair” from the Symposium “Where Science meets Clinics” (September 5-7, 2013, Davos) gathered leaders from medicine, science, industry, and regulatory organisations to debate the vision of cell therapy in Articular Cartilage Repair and the measures that could be taken to narrow the gap between vision and current practice. Cell-based therapy is already in clinical use to enhance the Repair of Cartilage lesions, with procedures such as microfracture and Articular chondrocyte implantation. However, even though long term follow up is good from a clinical perspective and some of the most rigorous randomised controlled trials in the regenerative medicine/orthopaedics field show beneficial effect, none of these options have proved successful in restoring the original Articular Cartilage structure and functionality in patients so far. With the remarkable recent advances in experimental research in cell biology (new sources for chondrocytes, stem cells), molecular biology (growth factors, genes), biomaterials, biomechanics, and translational science, a combined effort between scientists and clinicians with broad expertise may allow development of an improved cell therapy for Cartilage Repair. This position paper describes the current state of the art in the field to help define a procedure adapted to the clinical situation for upcoming translation in the patient.

Treatment and Prevention of (Early) Osteoarthritis Using Articular Cartilage Repair—Fact or Fiction? A Systematic Review

Early osteoarthritis (OA) is increasingly being recognized in patients who wish to remain active while not accepting the limitations of conservative treatment or joint replacement. The aim of this systematic review was to evaluate the existing evidence for treatment of patients with early OA using Articular Cartilage Repair techniques. A systematic search was performed in EMBASE, MEDLINE, and the Cochrane collaboration. Articles were screened for relevance and appraised for quality. Nine articles of generally low methodological quality (mean Coleman score 58) including a total of 502 patients (mean age range = 36-57 years) could be included. In the reports, both radiological and clinical criteria for early OA were applied. Of all patients included in this review, 75% were treated with autologous chondrocyte implantation. Good short-term clinical outcome up to 9 years was shown. Failure rates varied from 8% to 27.3%. The conversion to total knee arthroplasty rate was 2.5% to 6.5%. Although a (randomized controlled) trial in this patient category with long-term follow-up is needed, the literature suggests autologous chondrocyte implantation could provide good short- to mid-term clinical outcome and delay the need for total knee arthroplasty. The use of standardized criteria for early OA and implementation of (randomized) trials with long-term follow-up may allow for further expansion of the research field in Articular Cartilage Repair to the challenging population with (early) OA.

is magnetic resonance imaging reliable in predicting clinical outcome after Articular Cartilage Repair of the knee a systematic review and meta analysis

Background: While MRI can provide a detailed morphological evaluation after Articular Cartilage Repair, its additional value in determining clinical outcome has yet to be determined.

Purpose: To evaluate the correlation between MRI and clinical outcome after Cartilage Repair and to identify parameters that are most important in determining clinical outcome.

Study Design: Systematic review and meta-analysis.

Methods: A systematic search was performed in Embase, MEDLINE, and the Cochrane Collaboration. Articles were screened for relevance and appraised for quality. Guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement were used. Chi-square tests were performed to find variables that could determine correlation between clinical and radiological parameters.

Results: A total of 32 articles (total number of patients, 1019) were included. A majority (81%) were case series or cohort studies that used similar standardized MRI techniques. The mean Coleman score was 63 (range, 42-96). For the majority of MRI parameters, limited or no correlation was found. Nine studies (28%) found a correlation between clinical outcome and the composite magnetic resonance observation of Cartilage Repair tissue (MOCART) or Henderson score and 7 (22%) with defect fill. In 5 studies, a weak to moderate correlation was found between clinical outcome and the T2 index (mean Pearson coefficient r = .53).

Conclusion: Strong evidence to determine whether morphological MRI is reliable in predicting clinical outcome after Cartilage Repair is lacking. Future research aiming specifically at clinical sensitivity of advanced morphological and biochemical MRI techniques after Articular Cartilage Repair could be of great importance to the field.