Arthroscopic versus open matrix-induced autologous chondrocyte implantation: Results and implications for rehabilitation

Peter Edwards, Jay Ebert, G.C. Janes, David Wood, M.T. Fallon, Tim Ackland

    Research output: Contribution to journalArticle

    11 Citations (Scopus)

    Abstract

    © 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic technique, which may decrease the associated comorbidity of arthrotomy, potentially allowing for faster rehabilitation. Objective: To compare postoperative outcomes between arthroscopic and open arthrotomy techniques of MACI and present a case for faster recovery and accelerated rehabilitation after surgery. Design: Retrospective cohort study. Setting: Private functional rehabilitation facility. Patients: 78 patients (41 arthroscopic, 37 open) treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: According to surgeon preference, patients recruited over the same time period underwent MACI performed arthroscopically or via a conventional open arthrotomy. Both surgical groups were subjected to an identical rehabilitation protocol. Main Outcome Measures: Patient-reported (Knee Injury and Osteoarthritis Outcome Score, Short Form Health Survey, and visual analogue scale) and functional (6-minwalk test, 3-repetition straight-leg-raise test [3R-SLR]) outcomes were compared presurgery and at 3, 6, and 12 mo postsurgery. Active knee range of motion (ROM) was additionally assessed 4 and 8 wk postsurgery. MRI evaluation was assessed using magnetic-resonance observation of cartilage-repair tissue (MOCART) scores at 3 and 12 mo. The length of hospital stay was evaluated, while postsurgery complications were documented. Results: Significant improvements (P <.05) for both groups were observed over the 12-mo period for patient-reported and functional outcomes; however, the arthroscopic cohort performed significantly better (P <.05) in active knee-flexion and-extension ROM and the 3R-SLR. No differences were observed in MOCART scores between the 2 groups at 12 mo. Patients who received arthroscopic implantation required a significantly reduced (P <.001) hospital stay and experienced fewer postoperative complications. Conclusions: Arthroscopic MACI in combination with "best practice" rehabilitation has shown encouraging early results, with good clinical outcomes to 12 mo, reduced length of patient hospitalization, and reduced risk of postsurgery complications. This may have important implications for postoperative rehabilitation and a faster return to full function.
    Original languageEnglish
    Pages (from-to)203-215
    Number of pages13
    JournalJournal of Sport Rehabilitation
    Volume23
    Issue number3
    DOIs
    Publication statusPublished - Aug 2014

    Fingerprint

    Chondrocytes
    Rehabilitation
    Cartilage
    Length of Stay
    Knee
    Articular Range of Motion
    Leg
    Magnetic Resonance Spectroscopy
    Observation
    Knee Injuries
    Patient Preference
    Knee Osteoarthritis
    Thigh
    Health Surveys
    Visual Analog Scale
    Practice Guidelines
    Comorbidity
    Hospitalization
    Cohort Studies
    Retrospective Studies

    Cite this

    @article{fa29de67d8fd46139164d63f5f172145,
    title = "Arthroscopic versus open matrix-induced autologous chondrocyte implantation: Results and implications for rehabilitation",
    abstract = "{\circledC} 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic technique, which may decrease the associated comorbidity of arthrotomy, potentially allowing for faster rehabilitation. Objective: To compare postoperative outcomes between arthroscopic and open arthrotomy techniques of MACI and present a case for faster recovery and accelerated rehabilitation after surgery. Design: Retrospective cohort study. Setting: Private functional rehabilitation facility. Patients: 78 patients (41 arthroscopic, 37 open) treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: According to surgeon preference, patients recruited over the same time period underwent MACI performed arthroscopically or via a conventional open arthrotomy. Both surgical groups were subjected to an identical rehabilitation protocol. Main Outcome Measures: Patient-reported (Knee Injury and Osteoarthritis Outcome Score, Short Form Health Survey, and visual analogue scale) and functional (6-minwalk test, 3-repetition straight-leg-raise test [3R-SLR]) outcomes were compared presurgery and at 3, 6, and 12 mo postsurgery. Active knee range of motion (ROM) was additionally assessed 4 and 8 wk postsurgery. MRI evaluation was assessed using magnetic-resonance observation of cartilage-repair tissue (MOCART) scores at 3 and 12 mo. The length of hospital stay was evaluated, while postsurgery complications were documented. Results: Significant improvements (P <.05) for both groups were observed over the 12-mo period for patient-reported and functional outcomes; however, the arthroscopic cohort performed significantly better (P <.05) in active knee-flexion and-extension ROM and the 3R-SLR. No differences were observed in MOCART scores between the 2 groups at 12 mo. Patients who received arthroscopic implantation required a significantly reduced (P <.001) hospital stay and experienced fewer postoperative complications. Conclusions: Arthroscopic MACI in combination with {"}best practice{"} rehabilitation has shown encouraging early results, with good clinical outcomes to 12 mo, reduced length of patient hospitalization, and reduced risk of postsurgery complications. This may have important implications for postoperative rehabilitation and a faster return to full function.",
    author = "Peter Edwards and Jay Ebert and G.C. Janes and David Wood and M.T. Fallon and Tim Ackland",
    year = "2014",
    month = "8",
    doi = "10.1123/jsr.2013-0042",
    language = "English",
    volume = "23",
    pages = "203--215",
    journal = "Journal of Sport Rehabilitation",
    issn = "1056-6716",
    publisher = "Human Kinetics Publishers",
    number = "3",

    }

    Arthroscopic versus open matrix-induced autologous chondrocyte implantation: Results and implications for rehabilitation. / Edwards, Peter; Ebert, Jay; Janes, G.C.; Wood, David; Fallon, M.T.; Ackland, Tim.

    In: Journal of Sport Rehabilitation, Vol. 23, No. 3, 08.2014, p. 203-215.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Arthroscopic versus open matrix-induced autologous chondrocyte implantation: Results and implications for rehabilitation

    AU - Edwards, Peter

    AU - Ebert, Jay

    AU - Janes, G.C.

    AU - Wood, David

    AU - Fallon, M.T.

    AU - Ackland, Tim

    PY - 2014/8

    Y1 - 2014/8

    N2 - © 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic technique, which may decrease the associated comorbidity of arthrotomy, potentially allowing for faster rehabilitation. Objective: To compare postoperative outcomes between arthroscopic and open arthrotomy techniques of MACI and present a case for faster recovery and accelerated rehabilitation after surgery. Design: Retrospective cohort study. Setting: Private functional rehabilitation facility. Patients: 78 patients (41 arthroscopic, 37 open) treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: According to surgeon preference, patients recruited over the same time period underwent MACI performed arthroscopically or via a conventional open arthrotomy. Both surgical groups were subjected to an identical rehabilitation protocol. Main Outcome Measures: Patient-reported (Knee Injury and Osteoarthritis Outcome Score, Short Form Health Survey, and visual analogue scale) and functional (6-minwalk test, 3-repetition straight-leg-raise test [3R-SLR]) outcomes were compared presurgery and at 3, 6, and 12 mo postsurgery. Active knee range of motion (ROM) was additionally assessed 4 and 8 wk postsurgery. MRI evaluation was assessed using magnetic-resonance observation of cartilage-repair tissue (MOCART) scores at 3 and 12 mo. The length of hospital stay was evaluated, while postsurgery complications were documented. Results: Significant improvements (P <.05) for both groups were observed over the 12-mo period for patient-reported and functional outcomes; however, the arthroscopic cohort performed significantly better (P <.05) in active knee-flexion and-extension ROM and the 3R-SLR. No differences were observed in MOCART scores between the 2 groups at 12 mo. Patients who received arthroscopic implantation required a significantly reduced (P <.001) hospital stay and experienced fewer postoperative complications. Conclusions: Arthroscopic MACI in combination with "best practice" rehabilitation has shown encouraging early results, with good clinical outcomes to 12 mo, reduced length of patient hospitalization, and reduced risk of postsurgery complications. This may have important implications for postoperative rehabilitation and a faster return to full function.

    AB - © 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic technique, which may decrease the associated comorbidity of arthrotomy, potentially allowing for faster rehabilitation. Objective: To compare postoperative outcomes between arthroscopic and open arthrotomy techniques of MACI and present a case for faster recovery and accelerated rehabilitation after surgery. Design: Retrospective cohort study. Setting: Private functional rehabilitation facility. Patients: 78 patients (41 arthroscopic, 37 open) treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: According to surgeon preference, patients recruited over the same time period underwent MACI performed arthroscopically or via a conventional open arthrotomy. Both surgical groups were subjected to an identical rehabilitation protocol. Main Outcome Measures: Patient-reported (Knee Injury and Osteoarthritis Outcome Score, Short Form Health Survey, and visual analogue scale) and functional (6-minwalk test, 3-repetition straight-leg-raise test [3R-SLR]) outcomes were compared presurgery and at 3, 6, and 12 mo postsurgery. Active knee range of motion (ROM) was additionally assessed 4 and 8 wk postsurgery. MRI evaluation was assessed using magnetic-resonance observation of cartilage-repair tissue (MOCART) scores at 3 and 12 mo. The length of hospital stay was evaluated, while postsurgery complications were documented. Results: Significant improvements (P <.05) for both groups were observed over the 12-mo period for patient-reported and functional outcomes; however, the arthroscopic cohort performed significantly better (P <.05) in active knee-flexion and-extension ROM and the 3R-SLR. No differences were observed in MOCART scores between the 2 groups at 12 mo. Patients who received arthroscopic implantation required a significantly reduced (P <.001) hospital stay and experienced fewer postoperative complications. Conclusions: Arthroscopic MACI in combination with "best practice" rehabilitation has shown encouraging early results, with good clinical outcomes to 12 mo, reduced length of patient hospitalization, and reduced risk of postsurgery complications. This may have important implications for postoperative rehabilitation and a faster return to full function.

    U2 - 10.1123/jsr.2013-0042

    DO - 10.1123/jsr.2013-0042

    M3 - Article

    VL - 23

    SP - 203

    EP - 215

    JO - Journal of Sport Rehabilitation

    JF - Journal of Sport Rehabilitation

    SN - 1056-6716

    IS - 3

    ER -