Return to Sport in Professional Athletes After Cartilage Restoration Surgery of the Knee: A Systematic Review and Meta-Analysis Demonstrates Gender Inequality and the Need for Improved Reporting.

IF 2.7 4区医学 Q1 ORTHOPEDICS CARTILAGE Pub Date : 2024-12-17 DOI:10.1177/19476035241292793

Kyle N Kunze, Robert N Uzzo, Zach D Thomas, Justin Hicks, Scott A Rodeo, Riley J Williams

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Abstract

Objective: To synthesize the literature concerning return to sport (RTS) and related outcomes after cartilage restoration surgery of the knee in professional athletes.

Design: Cochrane, PubMed, and OVID/Medline databases were queried for data pertaining to RTS after knee cartilage surgery in professional athletes. Demographic information, cartilage lesion characteristics, and RTS-specific information were extracted. Freeman-Tukey Double-Arscine Transformations with Dersimonian-Laerd random-effects estimators were constructed to quantitatively describe the cumulative incidence of RTS, while heterogeneous data described narratively.

Results: Eleven studies (476 athletes; mean age 27.5 ± 2.1 years; 96.6% male) were included. Nine (81.8%) studies investigated a form of microfracture as treatment, with 6 (54.5%) performing isolated microfracture. The remaining studies investigated osteochondral allograft transplantation and mosaicplasty. More than half (n = 6; 54.5%) did not report cartilage lesion location or size. The pooled RTS rate was 84.3% (95% CI: 75.4%-91.8%) at a mean 39.9 (range, 12-104) weeks postoperatively. In 6 studies reporting competition level, a trend toward returning to a lower than pre-injury level was observed. The definition of RTS was only provided in 6 (54.5%) studies, while the criteria for RTS was only reported in 2 (18.2%) studies, suggesting limited transparency. One study reported an objective imaging assessment of reparative tissue, while none reported formal RTS testing protocols or minimum RTS timeline.

Conclusion: Although the majority of professional athletes are reported to achieve a successful RTS after cartilage restoration surgery of the knee, the literature predominantly reflects microfracture treatment. Current limitations in this literature include a substantial lack of female representation and infrequent reporting of cartilage lesion characteristics, rehabilitation and RTS criteria, and objective imaging assessments of reparative tissue.

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专业运动员膝关节软骨修复手术后重返运动：系统回顾和荟萃分析表明性别不平等和改进报告的必要性。

目的：综合有关专业运动员膝关节软骨修复术后重返运动（RTS）及相关预后的文献。设计：通过Cochrane、PubMed和OVID/Medline数据库查询专业运动员膝关节软骨手术后RTS的相关数据。提取人口统计学信息、软骨病变特征和rts特异性信息。构建了带有dersimonan - laerd随机效应估计器的Freeman-Tukey双arscine变换，以定量描述RTS的累积发生率，而异构数据则以叙事方式描述。结果：11项研究(476名运动员；平均年龄27.5±2.1岁；96.6%为男性)。9个（81.8%）研究了一种形式的微骨折作为治疗方法，6个（54.5%）研究了孤立的微骨折。其余的研究探讨了同种异体骨软骨移植和镶嵌成形术。超过一半(n = 6；54.5%)未报告软骨病变位置或大小。术后平均39.9周（范围12-104周），合并RTS率为84.3% （95% CI: 75.4%-91.8%）。在6项报告比赛水平的研究中，观察到回归到低于受伤前水平的趋势。只有6项（54.5%）研究提供了RTS的定义，而只有2项（18.2%）研究报告了RTS的标准，这表明透明度有限。一项研究报道了修复组织的客观影像学评估，而没有报道正式的RTS测试方案或最小RTS时间表。结论：虽然大多数专业运动员在膝关节软骨修复手术后获得了成功的RTS，但文献主要反映的是微骨折治疗。目前该文献的局限性包括缺乏女性代表，软骨病变特征、康复和RTS标准以及修复组织的客观影像学评估的报道很少。

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来源期刊

CARTILAGE ORTHOPEDICS-

CiteScore

6.90

自引率

7.10%

发文量

期刊介绍： CARTILAGE publishes articles related to the musculoskeletal system with particular attention to cartilage repair, development, function, degeneration, transplantation, and rehabilitation. The journal is a forum for the exchange of ideas for the many types of researchers and clinicians involved in cartilage biology and repair. A primary objective of CARTILAGE is to foster the cross-fertilization of the findings between clinical and basic sciences throughout the various disciplines involved in cartilage repair. The journal publishes full length original manuscripts on all types of cartilage including articular, nasal, auricular, tracheal/bronchial, and intervertebral disc fibrocartilage. Manuscripts on clinical and laboratory research are welcome. Review articles, editorials, and letters are also encouraged. The ICRS envisages CARTILAGE as a forum for the exchange of knowledge among clinicians, scientists, patients, and researchers. The International Cartilage Repair Society (ICRS) is dedicated to promotion, encouragement, and distribution of fundamental and applied research of cartilage in order to permit a better knowledge of function and dysfunction of articular cartilage and its repair.