Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes?
BACKGROUND
Despite improvement in treatment for articular cartilage lesions, prolonged recovery still precludes early return to competitive sports. The challenge of postoperative rehabilitation is to optimize return to preinjury activities without jeopardizing the graft.


OBJECTIVE
Intensive rehabilitation after second-generation arthroscopic autologous cartilage implantation (Hyalograft C) facilitates graft maturation and safely allows for early return to competition without jeopardizing clinical outcome at longer follow-up.


METHODS
Cohort study; Level of evidence, 3.


METHODS
The outcome of 31 competitive male athletes with International Cartilage Repair Society grade III-IV cartilaginous lesions of the medial or lateral femoral condyle or trochlea were evaluated at 1-, 2-, and 5-year follow-up. The athletic cohort was compared with a similar control cohort of 34 nonathletic patients who were treated with autologous chondrocyte implantation. The athletic cohort followed a 4-phase intensive rehabilitation protocol. Eleven of the patients in this cohort were also treated with an isokinetic exercise program and on-field rehabilitation. The patients in the control cohort completed only phase 1 of rehabilitation.


RESULTS
When comparing the 2 groups, a greater improvement in the group of athletes was achieved at 5-year follow-up (P = .037) in the self-assessment of quality of life and International Knee Documentation Committee subjective evaluation at 12 months and at 5 years of follow-up (P = .001 and P = .002, respectively). When analyzing the return to sports activity, 80.6% of the athletes returned to their previous activity level in 12.4 +/- 1.6 months; athletes treated with the on-field rehabilitation and isokinetic exercise program had faster recovery and an even earlier return to competition (10.6 +/- 2.0 months).


CONCLUSIONS
For optimal results, autologous chondrocyte implantation rehabilitation should not only follow but also facilitate the process of graft maturation. Intensive rehabilitation may safely allow a faster return to competition and also influence positively the clinical outcome at medium-term follow-up.
Della Villa
Stefano
S
Education Research Department, Isokinetic Medical Group, Bologna, Italy.
Kon
Elizaveta
E
Filardo
Giuseppe
G
Ricci
Margherita
M
Vincentelli
Ferruccio
F
Delcogliano
Marco
M
Marcacci
Maurilio
M
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001182:Arthroscopy; D001265:Athletic Injuries / Q000534:rehabilitation*; D016022:Case-Control Studies; D019902:Chondrocytes / Q000637:transplantation*; D003163:Competitive Behavior; D006305:Health Status Indicators; D006801:Humans; D007558:Italy; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult