Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes?

Stefano Della Villa, Elizaveta Kon, Giuseppe Filardo, Margherita Ricci, Ferruccio Vincentelli, Marco Delcogliano, Maurilio Marcacci

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

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. Hypothesis: 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. Study Design: 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)68-77
Number of pages10
JournalAmerican Journal of Sports Medicine
Volume38
Issue number1
DOIs
Publication statusPublished - Jan 2010

Fingerprint

Chondrocytes
Athletes
Rehabilitation
Transplants
Cartilage
Sports
Exercise Therapy
Articular Cartilage
Thigh
Return to Sport
Documentation
Knee
Cohort Studies
Quality of Life
Exercise
Bone and Bones

Keywords

  • Autologous chondrocyte transplantation
  • Cartilage regeneration
  • High-level athletes
  • Rehabilitation
  • Sport resumption

ASJC Scopus subject areas

  • Medicine(all)
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? / Villa, Stefano Della; Kon, Elizaveta; Filardo, Giuseppe; Ricci, Margherita; Vincentelli, Ferruccio; Delcogliano, Marco; Marcacci, Maurilio.

In: American Journal of Sports Medicine, Vol. 38, No. 1, 01.2010, p. 68-77.

Research output: Contribution to journalArticle

Villa, Stefano Della ; Kon, Elizaveta ; Filardo, Giuseppe ; Ricci, Margherita ; Vincentelli, Ferruccio ; Delcogliano, Marco ; Marcacci, Maurilio. / Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes?. In: American Journal of Sports Medicine. 2010 ; Vol. 38, No. 1. pp. 68-77.
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AU - Kon, Elizaveta

AU - Filardo, Giuseppe

AU - Ricci, Margherita

AU - Vincentelli, Ferruccio

AU - Delcogliano, Marco

AU - Marcacci, Maurilio

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N2 - 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. Hypothesis: 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. Study Design: 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). Conclusion: 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.

AB - 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. Hypothesis: 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. Study Design: 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). Conclusion: 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.

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KW - Cartilage regeneration

KW - High-level athletes

KW - Rehabilitation

KW - Sport resumption

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