Kunze Kyle N, Mazzucco Michael, Thomas Zach, Uzzo Robert, Rodeo Scott A, Warren Russell F, Wickiewicz Thomas L, Williams Riley J
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2025 Jan 10:3635465241280975. doi: 10.1177/03635465241280975.
Continued advancements in cartilage surgery and an accumulating body of evidence warrants a contemporary synthesis of return to sport (RTS) outcomes to provide updated prognostic data and to better understand treatment response.
To perform an updated systematic review of RTS in athletes after knee cartilage restoration surgery.
Systematic review; Level of evidence, 4.
PubMed, OVID/Medline, and Cochrane databases were queried in October 2023 for studies reporting any RTS outcome after knee cartilage restoration surgery. Meta-analyses with inverse-variance proportion and DerSimonian-Laird random-effects estimators were applied to quantify overall RTS. Comparative proportional subgroup meta-analyses with relative odds ratios (ORs) were constructed to quantify (1) the influence of the procedure on RTS and (2) RTS ability (lower vs same/greater level of play) based on procedure, competition level, and specific sport.
A total of 52 studies (n = 2387) were included. The overall pooled RTS was 80.3% (95% CI, 73.3%-86.5%). Matrix-assisted chondrocyte implantation (MACI) (OR, 2.15) and osteochondral autograft transplantation system (OATS) (OR, 1.83) demonstrated the highest likelihoods of RTS at the same/greater level, while microfracture (MF) (OR, 0.78) was the only treatment demonstrating a higher likelihood of RTS at a lower level. The fastest mean RTS was observed after OATS (6.6 ± 2.6 months). Professional athletes demonstrated an OR of 1.01 for RTS at the same/greater level, whereas recreational/amateur athletes demonstrated an OR of 1.63; however, all professional athletes underwent MF, and recreational/amateur athletes who underwent MF demonstrated lower likelihoods of RTS (OR, 0.78), indicating a consistent association between MF and low RTS propensity. Basketball players demonstrated the lowest likelihood of RTS at the same/greater level (OR, 1.1), while American football and soccer were associated with high likelihoods of RTS (OR, 3 and 2.4, respectively) across all procedure types.
Cartilage restoration allows for high overall RTS, with OATS and MACI conferring the greatest propensity for RTS, while OATS allowed for the fastest RTS. Undergoing MF was associated with consistently poor RTS ability. This study identified several important associations between the level of RTS and clinically relevant factors when discussing RTS, with recreational/amateur athletes, soccer players, and American football players demonstrating a higher relative propensity to RTS.
软骨手术的持续进展以及越来越多的证据表明，有必要对恢复运动（RTS）的结果进行当代综合分析，以提供最新的预后数据，并更好地了解治疗反应。
对膝关节软骨修复手术后运动员的RTS进行最新的系统评价。
系统评价；证据等级，4级。
2023年10月检索了PubMed、OVID/Medline和Cochrane数据库，以查找报告膝关节软骨修复手术后任何RTS结果的研究。采用逆方差比例和DerSimonian-Laird随机效应估计器进行荟萃分析，以量化总体RTS。构建具有相对优势比（OR）的比较比例亚组荟萃分析，以量化：（1）手术对RTS的影响；（2）基于手术、比赛水平和特定运动的RTS能力（较低水平与相同/更高水平比赛）。
共纳入52项研究（n = 2387）。总体汇总的RTS为80.3%（95%CI，73.3%-86.5%）。基质辅助软骨细胞植入（MACI）（OR，2.15）和骨软骨自体移植系统（OATS）（OR，1.83）在相同/更高水平上显示出最高的RTS可能性，而微骨折（MF）（OR，0.78）是唯一显示在较低水平上有更高RTS可能性的治疗方法。OATS术后观察到最快的平均RTS（6.6±2.6个月）。职业运动员在相同/更高水平上的RTS的OR为1.01，而娱乐/业余运动员的OR为1.63；然而，所有职业运动员均接受了MF，接受MF的娱乐/业余运动员的RTS可能性较低（OR，0.78），表明MF与低RTS倾向之间存在一致的关联。篮球运动员在相同/更高水平上的RTS可能性最低（OR，1.1），而在所有手术类型中，美式足球和足球与高RTS可能性相关（分别为OR，3和2.4）。
软骨修复可实现较高的总体RTS，OATS和MACI的RTS倾向最大，而OATS的RTS速度最快。接受MF与始终较差的RTS能力相关。本研究在讨论RTS时确定了RTS水平与临床相关因素之间的几个重要关联，娱乐/业余运动员、足球运动员和美式足球运动员表现出较高的RTS相对倾向。
