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Radiological Assessment of Accelerated versus Traditional Approaches to Postoperative Rehabilitation following Matrix-Induced Autologous Chondrocyte Implantation.

Ebert JR, Fallon M, Robertson WB, Lloyd DG, Zheng MH, Wood DJ, Ackland T - Cartilage (2011)

Bottom Line: Both groups significantly improved (P < 0.05) in the MRI composite score and pertinent descriptors of graft repair throughout the postoperative period until 24 months postsurgery.Patient age, body mass index, chondral defect size, and duration of preoperative symptoms were significantly correlated (P < 0.05) with several MRI-based outcomes at 24 months, whereas there were no significant pertinent correlations (P > 0.05) observed between clinical and MRI-based outcomes.The accelerated WB approach was not detrimental to graft development at any stage throughout the postoperative assessment timeline from baseline to 24 months postsurgery and may potentially accelerate patient return to normal function, while reducing postoperative muscle loss, intra-articular adhesions, and associated gait abnormalities.

View Article: PubMed Central - PubMed

Affiliation: School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, Western Australia.

ABSTRACT

Objective: To assess the safety and efficacy of accelerated compared with traditional postoperative weightbearing (WB) rehabilitation following matrix-induced autologous chondrocyte implantation (MACI) of the knee, using MRI.

Methods: A randomized controlled study design was used to assess MRI-based outcomes of MACI grafts in 70 patients (45 men, 25 women) who underwent MACI to the medial or lateral femoral condyle, in combination with either traditional or accelerated approaches to postoperative WB rehabilitation. High-resolution MRI was undertaken and assessed 8 previously defined pertinent parameters of graft repair, as well as a combined MRI composite score at 3, 12, and 24 months postsurgery. The association between clinical and MRI-based outcomes, patient demographics, chondral defect parameters, and injury/surgery history was investigated.

Results: Both groups significantly improved (P < 0.05) in the MRI composite score and pertinent descriptors of graft repair throughout the postoperative period until 24 months postsurgery. There were no differences (P > 0.05) observed between the 2 groups. Patient age, body mass index, chondral defect size, and duration of preoperative symptoms were significantly correlated (P < 0.05) with several MRI-based outcomes at 24 months, whereas there were no significant pertinent correlations (P > 0.05) observed between clinical and MRI-based outcomes.

Conclusion: The accelerated WB approach was not detrimental to graft development at any stage throughout the postoperative assessment timeline from baseline to 24 months postsurgery and may potentially accelerate patient return to normal function, while reducing postoperative muscle loss, intra-articular adhesions, and associated gait abnormalities.

No MeSH data available.


Related in: MedlinePlus

Patient randomization and assessment throughout the trial.
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fig1-1947603510380902: Patient randomization and assessment throughout the trial.

Mentions: Patients enrolled in this trial were recruited at the Hollywood Functional Rehabilitation Clinic, in association with the University of Western Australia. A block randomization procedure (gender; age <40 years or >40 years) was used to allocate 70 patients (47 men, 23 women) to either traditional or accelerated rehabilitation pathways (Fig. 1), and all but 1 patient was retained up until 24 months postsurgery (motor vehicle accident resulting in death at 7 months postsurgery and subsequent exclusion from the study analysis). Only patients who underwent MACI to localized, full-thickness medial or lateral femoral condylar defects to the knee participated in this study. Further recruitment criteria included patients 15 to 65 years of age and deemed able to follow the rehabilitation program. Patients were excluded if they had a body mass index (BMI) >35 kg/m2, had ligamentous instability, had varus/valgus abnormalities (>5° tibiofemoral anatomic angle),14,16 had undergone a prior extensive meniscectomy, or had ongoing progressive inflammatory arthritis. The sample sizes used were based on an a priori power calculation that showed at least 22 subjects were required in each of the 2 groups to reveal differences at the 5% significance level, with 80% power. Patients provided their written informed consent prior to study participation, and ethics approval was obtained from the relevant university and hospital ethics committees.


Radiological Assessment of Accelerated versus Traditional Approaches to Postoperative Rehabilitation following Matrix-Induced Autologous Chondrocyte Implantation.

Ebert JR, Fallon M, Robertson WB, Lloyd DG, Zheng MH, Wood DJ, Ackland T - Cartilage (2011)

Patient randomization and assessment throughout the trial.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300786&req=5

fig1-1947603510380902: Patient randomization and assessment throughout the trial.
Mentions: Patients enrolled in this trial were recruited at the Hollywood Functional Rehabilitation Clinic, in association with the University of Western Australia. A block randomization procedure (gender; age <40 years or >40 years) was used to allocate 70 patients (47 men, 23 women) to either traditional or accelerated rehabilitation pathways (Fig. 1), and all but 1 patient was retained up until 24 months postsurgery (motor vehicle accident resulting in death at 7 months postsurgery and subsequent exclusion from the study analysis). Only patients who underwent MACI to localized, full-thickness medial or lateral femoral condylar defects to the knee participated in this study. Further recruitment criteria included patients 15 to 65 years of age and deemed able to follow the rehabilitation program. Patients were excluded if they had a body mass index (BMI) >35 kg/m2, had ligamentous instability, had varus/valgus abnormalities (>5° tibiofemoral anatomic angle),14,16 had undergone a prior extensive meniscectomy, or had ongoing progressive inflammatory arthritis. The sample sizes used were based on an a priori power calculation that showed at least 22 subjects were required in each of the 2 groups to reveal differences at the 5% significance level, with 80% power. Patients provided their written informed consent prior to study participation, and ethics approval was obtained from the relevant university and hospital ethics committees.

Bottom Line: Both groups significantly improved (P < 0.05) in the MRI composite score and pertinent descriptors of graft repair throughout the postoperative period until 24 months postsurgery.Patient age, body mass index, chondral defect size, and duration of preoperative symptoms were significantly correlated (P < 0.05) with several MRI-based outcomes at 24 months, whereas there were no significant pertinent correlations (P > 0.05) observed between clinical and MRI-based outcomes.The accelerated WB approach was not detrimental to graft development at any stage throughout the postoperative assessment timeline from baseline to 24 months postsurgery and may potentially accelerate patient return to normal function, while reducing postoperative muscle loss, intra-articular adhesions, and associated gait abnormalities.

View Article: PubMed Central - PubMed

Affiliation: School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, Western Australia.

ABSTRACT

Objective: To assess the safety and efficacy of accelerated compared with traditional postoperative weightbearing (WB) rehabilitation following matrix-induced autologous chondrocyte implantation (MACI) of the knee, using MRI.

Methods: A randomized controlled study design was used to assess MRI-based outcomes of MACI grafts in 70 patients (45 men, 25 women) who underwent MACI to the medial or lateral femoral condyle, in combination with either traditional or accelerated approaches to postoperative WB rehabilitation. High-resolution MRI was undertaken and assessed 8 previously defined pertinent parameters of graft repair, as well as a combined MRI composite score at 3, 12, and 24 months postsurgery. The association between clinical and MRI-based outcomes, patient demographics, chondral defect parameters, and injury/surgery history was investigated.

Results: Both groups significantly improved (P < 0.05) in the MRI composite score and pertinent descriptors of graft repair throughout the postoperative period until 24 months postsurgery. There were no differences (P > 0.05) observed between the 2 groups. Patient age, body mass index, chondral defect size, and duration of preoperative symptoms were significantly correlated (P < 0.05) with several MRI-based outcomes at 24 months, whereas there were no significant pertinent correlations (P > 0.05) observed between clinical and MRI-based outcomes.

Conclusion: The accelerated WB approach was not detrimental to graft development at any stage throughout the postoperative assessment timeline from baseline to 24 months postsurgery and may potentially accelerate patient return to normal function, while reducing postoperative muscle loss, intra-articular adhesions, and associated gait abnormalities.

No MeSH data available.


Related in: MedlinePlus