Summary

The aim of this scoping review was to map and present available evidence for rates of RTS after cartilage procedures in pivoting sports athletes. There was a high heterogeneity and range in rates of RTS in athletes participating in pivoting sports. Most studies reported high rates of return to sports; however, return to preinjury level was lower.

Abstract

Background

The return to sports (RTS) outcome is an important variable to consider when selecting knee cartilage treatment for both clinicians and athletes. However, there is significant variability in how RTS is defined in the literature currently. The outcome is specific to individual athletes and focuses on their sport-specific goals. To help the surgeon and patient, this review focused on RTS after focal chondral lesion surgery in pivoting sports where the prevalence of cartilage injuries and the cartilage load is particularly high. The aim of this scoping review was to map and present available evidence for rates of RTS after cartilage procedures in pivoting sports athletes. For this review, the following cartilage procedures were evaluated: microfracture, osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI).

Method

Scoping review design
Data sources: A search on PubMed (MEDLINE), CINAHL, and Cochrane Central Register of Controlled Trials was performed. Reference lists of included studies and forward citation tracking was performed to identify additional studies.
Eligibility criteria for selecting studies: Reported on the patients with focal nearly full or full thickness (grade III or IV) chondral defects or osteochondritis dissecans of the femoral condyles, trochlea, patella, or tibial plateau, and return to pivoting sports after cartilage surgery written in English language.

Results

Sixteen studies fulfilled the inclusion criteria. Seven studies reported on microfracture, 2 studies on OAT, 2 studies on OCA, 3 studies on ACI, 1 study on microfracture and OAT, and 1 study on microfracture and ACI. RTS and return to preinjury level after microfracture was reported in 44% to 83% and 25% to 75% of the patients respectively. The reported time to RTS varied between 6.2 to 10 months, and the mean defect size varied from 1.9 to 4.9 cm2. RTS and return to preinjury level after OATS was reported in 87% to 100% and 67 to 93% of the patients respectively. The reported time to RTS varied between 11.8 weeks to 6.5 months, and the mean defect size varied from 1.34 to 2.9 cm2. RTS and return to preinjury level after (OCA) was reported in 33% to 96% and 26 to 67% of the patients respectively. The reported time to RTS was 10.2 months, and the mean defect size varied from 2.1 to 6.4 cm2. RTS and return to preinjury level after ACI was reported in 33% to 96% and 26 to 67% of the patients respectively. The reported time to RTS was 10.2 months, and the mean defect size varied from 2.1 to 6.4 cm2.

Conclusions

There was a high heterogeneity and range in rates of RTS in athletes participating in pivoting sports. Most studies reported high rates of return to sports; however, return to preinjury level was lower. This data may be important to clinicians in shared decision making on the type of procedure to be performed and counseling pivoting sports athletes on prognosis and expected RTS rates.