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SPORTS MEDICINE CARTILAGE REPAIR
PRACTICAL EXAMPLE 2 Athlete 1: ‘Even though the doctor told me it was OK to go back to martial arts, I was not about to get back into a sport that puts a lot of pressure on the knee after going to this effort to repair it.’
Athlete 2: ‘If I choose to go back to playing sport, then it would be with trepidation. I’m not really prepared to put myself or my family through the long rehab programme again.’
Some athletes who return to sport opt for a lower-
impact sport, while others return to their original sport but with limitations in level, frequency and/or duration of training and competition.
Rapid progression of chondral disease in the lateral compartment of the knee following meniscectomy. Arthroscopy 2005;21:1505–1509
2. Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. British Journal of Sports Medicine 2001;35:402–408
3. Messner K, Maletius W. The long-term prognosis for severe damage to weight- bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthopaedica Scandinavica 1996;67:165–168 4. Brittberg M, Lindahl A, Nilsson A, et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. New England Journal of Medicine 1994;331:889–895 5. Hambly K. Articular cartilage repair. sportEx Medicine 2004;22:12–14 6. Mithoefer K, Peterson L, Mandelbaum BR, Minas T. Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. American Journal of Sports Medicine 2005;33:1639–1646 7. Bhosale AM, Richardson JB. Articular cartilage: structure, injuries and review of management. British Medical Bulletin 2008;87:77–95 8. Blevins FT, Steadman JR, Rodrigo JJ, Silliman J. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics 1998;21:761–767 9. Eckstein F, Lemberger B, Gratzke C, et al. In vivo cartilage deformation after different types of activity and its dependence on physical training status. Annals of the Rheumatic Diseases 2005;64:291–295 10. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surgery, Sports Traumatology, Arthroscopy 2005;13:213– 221 11. Gudas R, Kalesinskas RJ, Kimtys V, et al. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 2005;21:1066–1075
12. Micheli L, Curtis C, Shervin N. Articular cartilage repair in the adolescent athlete: is autologous chondrocyte implantation the answer? Clinical Journal of Sport Medicine 2006;16:465–470 13. Mithoefer K, Minas T, Peterson L, et al. Functional outcome of knee articular cartilage repair in adolescent athletes. American Journal of Sports Medicine 2005;33:1147–1153
14. Mithoefer K, Scopp JM, Mandelbaum BR. Articular cartilage repair in athletes. Instructional Course Lectures 2007;56:457–468 15. Mithoefer K, Williams RJ, 3rd, Warren RF, et al. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. American Journal of Sports Medicine 2006;34:1413–1418 16. Steadman JR, Briggs KK, Rodrigo JJ, et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11- year follow-up. Arthroscopy 2003;19:477– 484 17. Alford JW, Cole BJ. Cartilage restoration. Part 1: basic science, historical perspective, patient evaluation, and treatment options. American Journal of Sports Medicine 2005;33:295–306 18. Alford JW, Cole BJ. Cartilage restoration. Part 2: techniques, outcomes, and future directions. American Journal of Sports Medicine 2005;33:443–460 19. Ritchie PK, McCarty EC. Surgical management of cartilage defects in athletes. Clinics in Sports Medicine 2005;24:163– 174
20. Wilk KE, Briem K, Reinold MM, et al. Rehabilitation of articular lesions in the athlete’s knee. Journal of Orthopaedic and Sports Physical Therapy 2006;36:815–827 21. Jakobsen RB, Engebretsen L, Slauterbeck JR. An analysis of the quality of cartilage repair studies. Journal of Bone and Joint Surgery. American Volume 2005;87:2232–2239 22. Hambly K, Bobic V, Wondrasch B, et al. Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. American Journal of Sports Medicine 2006;34:1020–1038 23. Bailey A, Goodstone N, Roberts S, et al. Rehabilitation after Oswestry autologous- chondrocyte implantation: the OsCell Protocol. Journal of Sport Rehabilitation 2003;12:104–118 24. Reinold MM, Wilk KE, Macrina LC, et al. Current concepts in the rehabilitation following articular cartilage repair procedures in the knee. Journal of Orthopaedic
THE AUTHOR
Karen Hambly BSc (Hons) MCSP is a senior lecturer at London Metropolitan University, where she teaches undergraduate and postgraduate sports therapy students. Since 2003 Karen has developed a special interest in articular
cartilage repair rehabilitation and has published and presented in this field nationally and internationally. Alongside her teaching role Karen is undertaking a PhD on the health- related cognitions of patients undergoing articular cartilage repair of the knee. Karen is currently the co-chair of the International Cartilage Repair Society’s Sports Injury and Rehabilitation Committee. karen@cartilagehealth.com
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and Sports Physical Therapy 2006;36:774–794 25. Riegger-Krugh CL, McCarty EC, Robinson MS, Wegzyn DA. Autologous chondrocyte implantation: current surgery and rehabilitation. Medicine and Science in Sports and Exercise 2008;40:206– 214 26. Ebert JR, Robertson WB, Lloyd DG, et al. Traditional vs accelerated approaches to post-operative rehabilitation following matrix-induced autologous chondrocyte implantation (MACI): comparison of clinical, biomechanical and radiographic outcomes. Osteoarthritis and Cartilage 2008;16:1131–1140 27. Eckstein F, Hudelmaier M, Putz R. The effects of exercise on human articular cartilage. Journal of Anatomy 2006;208:491–512 28. Wood JJ, Malek MA, Frassica FJ, et al. Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration. Journal of Bone and Joint Surgery. American Volume 2006;88:503–507 29. Ebert JR, Ackland TR, Lloyd DG, Wood DJ. Accuracy of partial weight bearing after autologous chondrocyte implantation. Archives of Physical Medicine and Rehabilitation 2008;89:1528–1534 30. Hambly K. Cartilage repair rehabilitation: the human factor. Presented at the 6th International Cartilage Repair Society Congress, San Diego, CA, USA, 2006 31. Hambly K, Griva K. IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? American Journal of Sports Medicine 2008;36:1695–1704.
USEFUL WEBSITES AND ASSOCIATIONS n Cartilage Health: www.cartilagehealth.com n Cartilage Repair Center, Boston: www.cartilagerepaircenter.org n Cartilage Research Foundation: www.cartilagefoundation.org n Chester Knee Clinic & Cartilage Repair Centre: www.kneeclinic.info n International Cartilage Repair Society: www.cartilage.org n KNEEguru – http://tinyurl. com/4r6mlf