Education Research Department, Isokinetic Medical Group, Bologna, Italy.
Am J Sports Med. 2010 Jan;38(1):68-77. doi: 10.1177/0363546509348490.
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.
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.
Cohort study; Level of evidence, 3.
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.
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).
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.
尽管关节软骨损伤的治疗有所改善，但长时间的恢复期仍妨碍运动员重返竞技状态。术后康复的挑战在于在不危及移植物的情况下优化恢复到受伤前的活动水平。
第二代关节镜下自体软骨移植（Hyalograft C）后的强化康复促进移植物成熟，并在不危及长期随访临床结果的情况下安全地允许早期重返比赛。
队列研究；证据水平，3 级。
对 31 名患有国际软骨修复协会 III-IV 级股骨内侧或外侧髁或滑车软骨损伤的竞技男性运动员进行了 1、2 和 5 年的随访。将竞技组与 34 名接受自体软骨细胞移植的非竞技患者的相似对照组进行比较。竞技组遵循 4 个阶段的强化康复方案。该队列中有 11 名患者还接受了等速运动方案和现场康复治疗。对照组仅完成了康复的第 1 阶段。
在比较两组时，运动员组在 5 年随访时（P =.037）在自我评估的生活质量和国际膝关节文献委员会主观评估（分别在 12 个月和 5 年随访时，P =.001 和 P =.002）方面取得了更大的改善。在分析重返体育活动时，80.6%的运动员在 12.4±1.6 个月内恢复到以前的活动水平；接受现场康复和等速运动方案治疗的运动员康复更快，更早重返比赛（10.6±2.0 个月）。
为了获得最佳效果，自体软骨细胞移植的康复不仅应遵循，还应促进移植物成熟过程。强化康复可能安全地允许更快地重返比赛，并对中期随访的临床结果产生积极影响。
