title: Has the Standard of the Reporting of Rehabilitation Improved in Articular Cartilage Repair Studies Involving Third-Generation Autologous Chondrocyte Implantation in the Knee? A Systematic Review.
abstract: BACKGROUND
  Autologous chondrocyte implantation (ACI) is a tissue-engineered surgical technique initially developed for articular cartilage repair of isolated chondral lesions of the knee. Third generation techniques (ACI3) are now available that deliver autologous cultured chondrocytes into the defect using cell scaffolds. The successful outcomes of these techniques have some dependency on the pre and post-surgical patient rehabilitation.
  
  
  OBJECTIVE
  To determine if the standard of reporting for rehabilitation has improved in ACI3 studies; previous reviews in this field recommended describing the detail of this rehabilitation and patient compliance as integral elements.
  
  
  METHODS
  A computerized search was performed in March 2013. Criteria for inclusion were any studies that evaluated or described the process of ACI3 in the knee and subsequent rehabilitation. The modified Coleman Methodology Score (CMS) was used to rate the standard of reporting of rehabilitation and surgical procedures; review articles were also evaluated for quality using the Strength of Recommendation Taxonomy (SORT). Mean scores, odds ratios, 95% confidence intervals and Mann-Whitney U statistics were calculated.
  
  
  RESULTS
  An improvement in mean CMS was seen compared to previous reviews but rehabilitation reporting scores were lower than their surgical equivalent; significant association was seen between those studies with rehabilitator involvement and high scores in the individual CMS rehabilitation element. Predominant SORT scores of 2A indicated medium strength of recommendation.
  
  
  CONCLUSIONS
  The CMS provides a general overview of methodological quality but a more specialised tool to report on the quantitative and qualitative aspects of the rehabilitation process would assist in raising the standards. It is recommended that rehabilitation therapists are included as key members of research teams and are involved in the design, implementation and reporting of future studies.
authors.affiliation: The European School of Osteopathy, Kent, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Bright
authors.forename: Karen
authors.initials: K
authors.lastname: Hambly