A randomized trial
comparing accelerated and traditional approaches to postoperative weightbearing
rehabilitation after matrix-induced autologous chondrocyte implantation:
Findings at 5 years

Ebert
JR, Fallon M, Zheng MH, Wood DJ, & Ackland TR. The American Journal of
Sports Medicine. 2012; doi 10.1177/0363546512445167

Matrix-induced
autologous chondrocyte implantation (MACI) has been widely used to repair
cartilage defects within the knee. 
Rehabilitation following this surgery has been deemed critical to
successful outcomes, but unfortunately there is very little research describing
an optimal rehabilitation progression. 
The purpose of this randomized trial was to compare an accelerated
rehabilitation protocol to a traditional rehabilitation protocol at 5-years
post-MACI surgery.  The accelerated
rehabilitation group reached full weight-bearing at 8 weeks after surgery,
compared to 11 weeks for patients in the traditional rehabilitation group. This
was a continuation of a study, which reported the
accelerated group had less severe pain and better walking-time scores up to
2-years post-MACI surgery compared to a traditional rehabilitation
program.  Seventy patients were
previously randomized to either the accelerated or traditional rehabilitation
group, and followed up with clinical and radiographic assessment before surgery,
and at 3-, 6-, 12-, and 24-months, and 5-years after surgery.  Clinical evaluation consisted of
patient-reported outcomes (i.e., knee-specific outcomes, general health),
active range of motion, and a 6-minute walk test.  A blinded author also scored magnetic
resonance imaging to assess the joint (e.g., graft infill, effusion).  Both groups had an overall improvement in
magnetic resonance imaging scores, patient satisfaction, and clinical findings.  The only difference between groups at 5-years
post-surgery was that the accelerated group had a significantly lower frequency
of pain compared to the traditional rehabilitation group.

This
study is important because it provides support that an accelerated
rehabilitation after MACI surgery is safe and effective. This is not to suggest
that every patient should attempt an accelerated program but if the patient is
progressing nicely then it appears acceptable to allow them to follow an
accelerated protocol. It was also nice to see that an accelerated rehabilitation
program did not compromise any longer-term clinical or structural
findings.  However, it would be
interesting to follow these patients longer term, and monitor their magnetic
resonance imaging findings for degenerative changes and the development or
progression of osteoarthritis. How do you progress your patients after a MACI
surgeries? What types of activities do you think are ok to resume post-surgery?

Written by: Nicole Cattano & Jeffrey
Driban
Reviewed
by: Steven Thomas

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Ebert JR, Fallon M, Zheng MH, Wood DJ, & Ackland TR (2012). A randomized trial comparing accelerated and traditional approaches to postoperative weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation: findings at 5 years. The American journal of sports medicine, 40 (7), 1527-37 PMID: 22539536