The progression of isokinetic knee strength after matrix-induced autologous chondrocyte implantation: Implications for rehabilitation and return to activity

Jay Ebert, A.J. Smith, Peter Edwards, Tim Ackland

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    Abstract

    © 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb. Objective: To investigate the progression of isokinetic knee strength and limb symmetry after MACI. Design: Prospective cohort. Setting: Private functional rehabilitation facility. Patients: 58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: MACI and a standardized rehabilitation protocol. Main Outcome Measures: Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time. Results: Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0%, 83.0%, and 86.5% were observed at 1, 2, and 5 y, respectively, while 53.4-72.4% of patients demonstrated an LSI ≤ 90% across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points. Conclusions: While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90%, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.
    Original languageEnglish
    Pages (from-to)244-258
    Number of pages15
    JournalJournal of Sport Rehabilitation
    Volume23
    Issue number3
    DOIs
    Publication statusPublished - Aug 2014

    Fingerprint

    Chondrocytes
    Knee
    Rehabilitation
    Extremities
    Torque
    Cartilage
    Pain
    Thigh
    Hip
    Linear Models
    Leg
    Regression Analysis
    Demography
    Outcome Assessment (Health Care)
    Transplants
    Bone and Bones

    Cite this

    @article{d3d89082bd7248f3bf83e21b1afa3c35,
    title = "The progression of isokinetic knee strength after matrix-induced autologous chondrocyte implantation: Implications for rehabilitation and return to activity",
    abstract = "{\circledC} 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb. Objective: To investigate the progression of isokinetic knee strength and limb symmetry after MACI. Design: Prospective cohort. Setting: Private functional rehabilitation facility. Patients: 58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: MACI and a standardized rehabilitation protocol. Main Outcome Measures: Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time. Results: Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0{\%}, 83.0{\%}, and 86.5{\%} were observed at 1, 2, and 5 y, respectively, while 53.4-72.4{\%} of patients demonstrated an LSI ≤ 90{\%} across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points. Conclusions: While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90{\%}, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.",
    author = "Jay Ebert and A.J. Smith and Peter Edwards and Tim Ackland",
    year = "2014",
    month = "8",
    doi = "10.1123/JSR.2014-0159",
    language = "English",
    volume = "23",
    pages = "244--258",
    journal = "Journal of Sport Rehabilitation",
    issn = "1056-6716",
    publisher = "Human Kinetics Publishers",
    number = "3",

    }

    TY - JOUR

    T1 - The progression of isokinetic knee strength after matrix-induced autologous chondrocyte implantation: Implications for rehabilitation and return to activity

    AU - Ebert, Jay

    AU - Smith, A.J.

    AU - Edwards, Peter

    AU - Ackland, Tim

    PY - 2014/8

    Y1 - 2014/8

    N2 - © 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb. Objective: To investigate the progression of isokinetic knee strength and limb symmetry after MACI. Design: Prospective cohort. Setting: Private functional rehabilitation facility. Patients: 58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: MACI and a standardized rehabilitation protocol. Main Outcome Measures: Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time. Results: Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0%, 83.0%, and 86.5% were observed at 1, 2, and 5 y, respectively, while 53.4-72.4% of patients demonstrated an LSI ≤ 90% across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points. Conclusions: While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90%, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.

    AB - © 2014 Human Kinetics, Inc. Context: Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb. Objective: To investigate the progression of isokinetic knee strength and limb symmetry after MACI. Design: Prospective cohort. Setting: Private functional rehabilitation facility. Patients: 58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles. Intervention: MACI and a standardized rehabilitation protocol. Main Outcome Measures: Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time. Results: Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0%, 83.0%, and 86.5% were observed at 1, 2, and 5 y, respectively, while 53.4-72.4% of patients demonstrated an LSI ≤ 90% across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points. Conclusions: While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90%, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.

    U2 - 10.1123/JSR.2014-0159

    DO - 10.1123/JSR.2014-0159

    M3 - Article

    VL - 23

    SP - 244

    EP - 258

    JO - Journal of Sport Rehabilitation

    JF - Journal of Sport Rehabilitation

    SN - 1056-6716

    IS - 3

    ER -