title: Patient-oriented and performance-based outcomes after knee autologous chondrocyte implantation: a timeline for the first year of recovery.
abstract: BACKGROUND
  It is well established that autologous chondrocyte implantation (ACI) can require extended recovery postoperatively; however, little information exists to provide clinicians and patients with a timeline for anticipated function during the first year after ACI.
  
  
  OBJECTIVE
  To document the recovery of functional performance of activities of daily living after ACI.
  
  
  METHODS
  ACI patients (n = 48, 29 male; 35.1 ± 8.0 y).
  
  
  METHODS
  All patients completed functional tests (weight-bearing squat, walk-across, sit-to-stand, step-up/over, and forward lunge) using the NeuroCom long force plate (Clackamas, OR) and completed patient-reported outcome measures (International Knee Documentation Committee Subjective Knee Evaluation Form, Lysholm, Western Ontario and McMaster Osteoarthritis Index [WOMAC], and 36-Item Short-Form Health Survey) preoperatively and 3, 6, and 12 mo postoperatively.
  
  
  METHODS
  A covariance pattern model was used to compare performance and self-reported outcome across time and provide a timeline for functional recovery after ACI.
  
  
  RESULTS
  Participants demonstrated significant improvement in walk-across stride length from baseline (42.0% ± 8.9% height) at 6 (46.8% ± 8.1%) and 12 mo (46.6% ± 7.6%). Weight bearing on the involved limb during squatting at 30°, 60°, and 90° was significantly less at 3 mo than presurgery. Step-up/over time was significantly slower at 3 mo (1.67 ± 0.69 s) than at baseline (1.49 ± 0.33 s), 6 mo (1.51 ± 0.36 s), and 12 mo (1.40 ± 0.26 s). Step-up/over lift-up index was increased from baseline (41.0% ± 11.3% body weight [BW]) at 3 (45.0% ± 11.7% BW), 6 (47.0% ± 11.3% BW), and 12 mo (47.3% ± 11.6% BW). Forward-lunge time was decreased at 3 mo (1.51 ± 0.44 s) compared with baseline (1.39 ± 0.43 s), 6 mo (1.32 ± 0.05 s), and 12 mo (1.27 ± 0.06). Similarly, forward-lunge impact force was decreased at 3 mo (22.2% ± 1.4% BW) compared with baseline (25.4% ± 1.5% BW). The WOMAC demonstrated significant improvements at 3 mo. All patient-reported outcomes were improved from baseline at 6 and 12 mo postsurgery.
  
  
  CONCLUSIONS
  Patients' perceptions of improvements may outpace physical changes in function. Decreased function for at least the first 3 mo after ACI should be anticipated, and improvement in performance of tasks requiring weight-bearing knee flexion, such as squatting, going down stairs, or lunging, may not occur for a year or more after surgery.
authors.affiliation: Dept of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Howard
authors.forename: Carl G
authors.initials: CG
authors.lastname: Mattacola
authors.forename: David R
authors.initials: DR
authors.lastname: Mullineaux
authors.forename: Robert A
authors.initials: RA
authors.lastname: English
authors.forename: Christian
authors.initials: C
authors.lastname: Lattermann
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000379:methods*; D018802:Patient-Centered Care; D014182:Transplantation, Autologous / Q000534:rehabilitation