Physical Activity Levels After Characterized Chondrocyte Implantation Versus Microfracture in the Knee and the Relationship to Objective Functional Outcome With 2-year Follow-up

Abstract

Background: Characterized chondrocyte implantation results in superior structural repair compared with microfracture, but may be associated with a slower recovery of physical activity levels due to the arthrotomy.

Hypotheses: Our hypotheses were that (1) microfracture results in increased activity levels over 2 years after surgery compared with characterized chondrocyte implantation, (2) patients with high preinjury activity levels have a better functional outcome, and (3) high levels of low-load activities after surgery improve functional outcome.

Study Design: Cohort study; Level of evidence, 2.

Methods: Sixty-seven patients with local cartilage defects (mean size, 2.4 cm2; standard deviation, 1.5 cm2) of the femoral condyle underwent characterized chondrocyte implantation (n = 33) or microfracture (n = 34), followed by an identical rehabilitation protocol. Activity levels (assessed using the Activity Rating Scale) and functional outcome were determined at baseline, and 1 and 2 years after surgery. Functional outcome was based on the pooled symmetry index (derived from isokinetic knee extension strength and 3 one-legged hop tests). Patients’ participation in low-load activities during the first 3 months after surgery was assessed using rehabilitation data. Mixed linear model analyses and Wilcoxon rank sum tests were used.

Results: Activity levels in patients treated with characterized chondrocyte implantation and microfracture were comparable at 1 and 2 years after surgery. Preinjury activity levels showed no relationship to functional outcome. Lack of postoperative low-load activities resulted in a significantly worse functional outcome (mean pooled symmetry index 78.2%) compared with high levels of postoperative surgery low-load activities (mean pooled symmetry index 92.4%).

Conclusion: Despite differences between the characterized chondrocyte implantation and microfracture procedures, patients’ activity levels were comparable at 2 years after surgery. Lack of low-load activities after surgery adversely affected functional outcome.

Keywords

cartilage knee physical therapy surgery treatment outcome

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