High Variability in Return-to-Sport Assessment After Autologous Chondrocyte Implantation of the Knee: A Systematic Review

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Abstract
Purpose: To systematically review return-to-sport (RTS) patient-reported outcome measure (PROM) usage following autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI). We hypothesized that RTS reporting would be highly inconsistent, limiting clinical applicability. Methods: A systematic review was conducted using PubMed, Embase, and Scopus (January 1, 2014–December 8, 2024). Eligible studies reported RTS PROMs after ACI/MACI. Extracted data included study design, demographics, name and type of scale used, and assessment modality. Results: Of 807 studies screened, 85 met inclusion criteria. Measures used to report RTS varied widely. The Knee injury and Osteoarthritis Outcome Score–Sport/Rec and the International Knee Documentation Committee Subjective Knee Evaluation Form were the most commonly reported validated PROMs, included in 71.8% and 49.4% of studies, respectively. Only 15.3% of studies reported RTS as a postoperative percentage. Of all, 22.4% of studies used custom, nonvalidated tools. Most studies (49.4%) were prospective, and in-person evaluation was most common (52.8%). Timepoints of RTS measurement were inconsistent. Conclusions: RTS is inconsistently quantified following ACI/MACI, limiting cross-study comparisons and complicating clinical interpretation of outcomes. Standardized use of and expansion of validated PROMs is needed to improve the clinical applicability of data on RTS for ACI/MACI

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