Ebert Jay R, Janes Gregory C, Wood David J
Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, Western Australia, 6005, Australia.
School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, Western Australia, 6009.
Int J Sports Phys Ther. 2020 Feb;15(1):1-11.
Returning to a satisfactory activity level is expected by patients after cartilage repair, and may define overall surgical success.
To investigate: 1) the level and improvement in activity in patients at two years after matrix-induced autologous chondrocyte implantation (MACI), 2) what factors are associated with post-operative (and improvement in) activity level, and 3) whether patients are satisfied with their ability to participate in recreational and/or sporting activities.
Prospective cohort.
One hundred and fifty patients that underwent MACI were included in this analysis (83 tibiofemoral and 67 patellofemoral). All patients completed the Tegner Activity Scale (TAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-surgery and at two years (range: 24-26 months) post-surgery, as well as a questionnaire evaluating satisfaction with their ability to return to recreational and sporting activities.
The TAS significantly improved (p<0.001) from 2.97 (SD 0.92, range 0-7) to 4.09 (SD 1.49, range 0-9), while the KOOS Sport significantly improved (p<0.0001) from 27.5 (SD 23.1, range 0-95) to 61.1 (SD 27.3, range 0-100). Overall, 88 patients (59%) improved ≥ 1 point on the TAS, while 121 patients (81%) improved ≥ 10 points on the KOOS Sport, previously reported as the minimal detectable change for each. Patient age, duration of symptoms (DOS) and gender were associated with post-operative activity level, though body mass index (BMI), defect size and concomitant procedures were not. Overall, 128 patients (85%) were satisfied with their ability to return to recreational activities, with 99 (66%) satisfied with sport participation. The two-year TAS, and TAS improvement, were significantly associated with satisfaction in performing recreational activities (two-year TAS, rho=-0.42, p<0.0001; TAS improvement, r=-0.33, p<0.0001) and sport participation (two-year TAS, rho=-0.49, p<0.0001; TAS improvement, r=-0.37, p<0.0001).
The TAS and KOOS Sport significantly improved after MACI, though only 59% of patients improved ≥ 1 point on the TAS. Despite this, 85% and 66% of patients were satisfied with their ability to return to recreational activities and participate in sport, respectively. Age, DOS and gender were associated with activity, and overall these findings can be used to provide realistic activity expectations to patients undergoing MACI.
Level 3, prospective cohort study.
软骨修复术后患者期望恢复到令人满意的活动水平，这可能决定手术的整体成功与否。
研究：1）基质诱导自体软骨细胞植入术（MACI）后两年患者的活动水平及改善情况；2）哪些因素与术后活动水平（及其改善情况）相关；3）患者对其参与娱乐和/或体育活动的能力是否满意。
前瞻性队列研究。
本分析纳入了150例行MACI的患者（83例胫股关节，67例髌股关节）。所有患者在术前及术后两年（范围：24 - 26个月）完成了Tegner活动量表（TAS）和膝关节损伤与骨关节炎疗效评分（KOOS），以及一份评估其对恢复娱乐和体育活动能力满意度的问卷。
TAS从2.97（标准差0.92，范围0 - 7）显著提高到4.09（标准差1.49，范围0 - 9）（p < 0.001），而KOOS运动功能评分从27.5（标准差23.1，范围0 - 95）显著提高到61.1（标准差27.3，范围0 - 100）（p < 0.0001）。总体而言，88例患者（59%）的TAS提高了≥1分，而121例患者（81%）的KOOS运动功能评分提高了≥10分，此前报道这分别是二者的最小可检测变化。患者年龄、症状持续时间（DOS）和性别与术后活动水平相关，而体重指数（BMI）、缺损大小和伴随手术则无关。总体而言，128例患者（85%）对其恢复娱乐活动的能力感到满意，99例患者（66%）对参与体育活动感到满意。两年时的TAS及TAS的改善与进行娱乐活动的满意度显著相关（两年时的TAS，rho = -0.42，p < 0.0001；TAS改善，r = -0.33，p < 0.0001）以及与体育活动参与的满意度相关（两年时的TAS，rho = -0.49，p < 0.0001；TAS改善，r = -0.37，p < 0.0001）。
MACI术后TAS和KOOS运动功能评分显著提高，尽管只有59%的患者TAS提高了≥1分。尽管如此，分别有85%和66%的患者对其恢复娱乐活动和参与体育活动的能力感到满意。年龄、DOS和性别与活动相关，总体而言，这些发现可用于为接受MACI的患者提供现实的活动预期。
3级，前瞻性队列研究。
