A randomized trial comparing accelerated and traditional approaches to postoperative weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation: Findings at 5 years
Ebert JR, Fallon M, Zheng MH, Wood DJ, & Ackland TR. The American Journal of Sports Medicine. 2012; doi 10.1177/0363546512445167
Matrix-induced autologous chondrocyte implantation (MACI) has been widely used to repair cartilage defects within the knee. Rehabilitation following this surgery has been deemed critical to successful outcomes, but unfortunately there is very little research describing an optimal rehabilitation progression. The purpose of this randomized trial was to compare an accelerated rehabilitation protocol to a traditional rehabilitation protocol at 5-years post-MACI surgery. The accelerated rehabilitation group reached full weight-bearing at 8 weeks after surgery, compared to 11 weeks for patients in the traditional rehabilitation group. This was a continuation of a study, which reported the accelerated group had less severe pain and better walking-time scores up to 2-years post-MACI surgery compared to a traditional rehabilitation program. Seventy patients were previously randomized to either the accelerated or traditional rehabilitation group, and followed up with clinical and radiographic assessment before surgery, and at 3-, 6-, 12-, and 24-months, and 5-years after surgery. Clinical evaluation consisted of patient-reported outcomes (i.e., knee-specific outcomes, general health), active range of motion, and a 6-minute walk test. A blinded author also scored magnetic resonance imaging to assess the joint (e.g., graft infill, effusion). Both groups had an overall improvement in magnetic resonance imaging scores, patient satisfaction, and clinical findings. The only difference between groups at 5-years post-surgery was that the accelerated group had a significantly lower frequency of pain compared to the traditional rehabilitation group.
This study is important because it provides support that an accelerated rehabilitation after MACI surgery is safe and effective. This is not to suggest that every patient should attempt an accelerated program but if the patient is progressing nicely then it appears acceptable to allow them to follow an accelerated protocol. It was also nice to see that an accelerated rehabilitation program did not compromise any longer-term clinical or structural findings. However, it would be interesting to follow these patients longer term, and monitor their magnetic resonance imaging findings for degenerative changes and the development or progression of osteoarthritis. How do you progress your patients after a MACI surgeries? What types of activities do you think are ok to resume post-surgery?
Written by: Nicole Cattano & Jeffrey Driban
Reviewed by: Steven Thomas
Ebert JR, Fallon M, Zheng MH, Wood DJ, & Ackland TR (2012). A randomized trial comparing accelerated and traditional approaches to postoperative weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation: findings at 5 years. The American journal of sports medicine, 40 (7), 1527-37 PMID: 22539536