Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis
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Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques.
A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model.
Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total, 2549 patients were included (1756 M, 793 F) with an average age of 35 years and follow-up of 47 months. Return to sport at some level was 76 % overall, with highest rates of return after OAT (93 %), followed by OCA (88 %), ACI (82 %), and MFX (58 %). Osteochondral autograft transfer showed the fastest return to sports (5.2 ± 1.8 months) compared to 9.1 ± 2.2 months for MFX, 9.6 ± 3.0 months for OCA and 11.8 ± 3.8 months for ACI (P < 0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport.
In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76 % return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects.
Level of evidence
KeywordsCartilage Return to sport Microfracture Osteochondral autograft transfer Osteochondral allograft transplantation Autologous chondrocyte implantation
Compliance with ethical standards
Conflict of interest
The authors report the following potential conflict of interest or source of funding: B.A.L. reports personal fees from Arthrex, Stryker, VOT Solutions, and Biomet, outside the submitted work. M.J.S. reports personal fees from Arthrex and Stryker, outside the submitted work and serves on the editorial or governing board for AJSM. R.J.W. reports personal fees from Arthrex, Cymedica, Histogenics Inc, Zimmer, R2T2 Laboratories, Springer and serves on the editorial or governing board of J. Robert Gladden Society. A.J.K. reports personal fees from Arthrex, Arthritis Foundation, and Histogenics, outside the submitted work.
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