Return-to-Play and Rehabilitation Protocols following Cartilage Restoration Procedures of the Knee: A Systematic Review

Objective The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return-to-play guidelines, and subsequent rates of return to play following cartilage restoration procedures in the knee. Design MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA guidelines to find studies on cartilage restoration procedures in the knee, including (1) microfracture (Mfx), (2) osteochondral autograft transfer (AOT), (3) osteochondral allograft implantation (OCA), and (4) autologous chondrocyte implantation (ACI). Studies were included if they reported return-to-play data or rehabilitation protocols. Results Overall, 179 studies fit our inclusion criteria, with 48 on Mfx, 34 on AOT, 54 on OCA, and 51 on ACI. The rate of return to play was reported as high as 88.2% with AOT, and as low as 77.2% following OCA, with rates of return to play at the same/higher level as high as 79.3% with AOT, and as low as 57.3% following ACI. The average reported time of return to play was as low as 4.9 months with AOT, and as high as 11.6 months following ACI. Conclusions The majority of patients are able to return to play following cartilage restoration procedures in the knee, regardless of surgical procedure utilized. However, while the rate of return to play at the same level was similar to the overall rate of return following AOT, there was a large number of patients unable to return to the same level following Mfx, OCA, and ACI. Additionally, there is wide variety in the rehabilitation protocols, and scant literature on return-to-play protocols.

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Return to Play and Rehabilitation Protocols following Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00392 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0039

Author(s):

Yoshiharu Shimozono ◽

Dexter Seow ◽

Arianna L Gianakos ◽

Eugenio Chiarello ◽

John G. Kennedy

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Return To Play ◽

Rate Of Return ◽

Osteochondral Lesions ◽

Osteochondral Transplantation ◽

Autologous Osteochondral Transplantation ◽

Rates Of Return ◽

Rehabilitation Protocols

Category: Ankle, Sports Introduction/Purpose: Autologous osteochondral transplantation (AOT) has demonstrated favourable outcomes in the treatment of osteochondral lesions of the talus (OLT). Recent studies have reported high rates of return to play sports following AOT for OLT, however variable rates of return to play have been reported ranging from 50 to 95%. In addition, little information regarding optimal standardized rehabilitation protocols and return to play guidelines has been demonstrated. The purpose of this study is to determine the rate of return to play following AOT for OLT by systematic review and meta-analysis and report subsequent rehabilitation protocols. Methods: The MEDLINE, EMBASE and The Cochrane Library databases was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using specific inclusion/exclusion criteria. The quality of evidence was evaluated using the Modified Coleman Methodology Score (MCMS). Predetermined data was extracted on a datasheet with the return to play calculated as a percentage of patients that returned to sport. Rehabilitation protocols were recorded as the earliest time that range of motion, partial weightbearing and full weightbearing commenced was recorded. The quality of return to play guidelines in each study was evaluated based on the criteria by Zaman et al. Well defined return to play criteria was allocated a score of 4, poorly defined criteria allocated a score between 1 to 3 and no return to play criteria allocated 0. The meta-analysis of return to play was performed using previously published criteria. Results: The search strategy yielded 8 studies evaluating 200 ankles with a mean follow-up of 44.3 ± 26.8 months (range, 16 to 84 months), mean age of 31.3 ± 6.92 years (range, 22.7 to 42 years) and mean OLT size of 119.2 ± 35.3 mm2 (range, 68.9 to 180 mm2). The mean time to return to play was 4.55 ± 2.19 months (range, 3 to 6.1 months). The reported rates of return to play ranged from 50% to 95.2%. The accumulative rate of return to play was 83.8% (140/167), with 77.4% (48/62) of athletes returning to pre-injury status. Based on the fixed-effect model, the rate of return to play was 81.5% (Figure 1). The quality of return to play criteria was poor in all. Conclusion: This systematic review indicates high rate of return to play following AOT in the athletic population. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. The included studies were of low level and quality of evidence, therefore, further well-designed studies are warranted to sufficiently improve the reporting accuracy for rate of return to play.

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Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis

Cartilage ◽

10.1177/19476035211011515 ◽

2021 ◽

pp. 194760352110115

Author(s):

Jacob G. Calcei ◽

Kunal Varshneya ◽

Kyle R. Sochacki ◽

Marc R. Safran ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Cohort Analysis ◽

Reoperation Rate ◽

Similar Rate ◽

Osteochondral Allograft ◽

Complication Rates ◽

Cartilage Restoration ◽

Chondrocyte Implantation ◽

The Cost ◽

Reoperation Rates

Objective The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy. Study Design Retrospective cohort study, level III. Design Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated. Results A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively. Conclusions Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.

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Return to Play After Hip Arthroscopy: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546518759731 ◽

2018 ◽

Vol 46 (11) ◽

pp. 2780-2788 ◽

Cited By ~ 24

Author(s):

Michaela O’Connor ◽

Anas A. Minkara ◽

Robert W. Westermann ◽

James Rosneck ◽

T. Sean Lynch

Keyword(s):

Systematic Review ◽

Hip Arthroscopy ◽

Meta Analysis ◽

Return To Play ◽

Sufficient Evidence ◽

Harris Hip Score ◽

Cochrane Library ◽

Evidence Based ◽

Rehabilitation Protocols ◽

The Mean

Background: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete’s preparedness for sporting activities. Purpose: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. Study Design: Systematic review and meta-analysis. Methods: The search terms “hip arthroscopy,” “return to play,” and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. Results: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = −0.95, P = .0003). Conclusion: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.

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Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

The Journal of Knee Surgery ◽

10.1055/s-0040-1712946 ◽

2020 ◽

Author(s):

Steven F. DeFroda ◽

Steven L. Bokshan ◽

Daniel S. Yang ◽

Alan H. Daniels ◽

Brett D. Owens

Keyword(s):

United States ◽

Sports Medicine ◽

Linear Trend ◽

The United States ◽

Osteochondral Allograft ◽

Osteochondral Autograft ◽

Cartilage Lesions ◽

Average Yearly Incidence ◽

Chondrocyte Implantation ◽

Osteochondral Autograft Transfer

AbstractManagement of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon “gold-standard” management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty) were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing incidence of palliative procedures seen by a significant decrease in the ratio of palliative to microfracture/restorative procedures of 0.2512 each year from 2007 to 2016 (p < 0.001). This decrease followed a linear trend (R 2 = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most commonly performed procedure for cartilage lesions in the United States from 2007 to 2016, as more surgeons opted for microfracture procedures instead. Restorative procedures (ACI, osteochondral autograft transfer system) remained unchanged over the study period, in accordance with the sports medicine literature; however, early functional outcomes studies do show the equivalency and in some cases superiority compared with microfracture. This is Level III study.

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Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119853218 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985321 ◽

Cited By ~ 3

Author(s):

John W. Belk ◽

Matthew J. Kraeutler ◽

Omer Mei-Dan ◽

Darby A. Houck ◽

Eric C. McCarty ◽

...

Keyword(s):

Systematic Review ◽

Surgical Intervention ◽

Return To Sport ◽

Hamstring Tendon ◽

Activity Level ◽

Return To Play ◽

Rate Of Return ◽

Cochrane Library ◽

Level Of Evidence ◽

Proximal Hamstring

Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

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Management of Large Focal Chondral and Osteochondral Defects in the Knee

The Journal of Knee Surgery ◽

10.1055/s-0040-1721053 ◽

2020 ◽

Vol 33 (12) ◽

pp. 1187-1200

Author(s):

Jacob G. Calcei ◽

Taylor Ray ◽

Seth L. Sherman ◽

Jack Farr

Keyword(s):

Articular Cartilage ◽

Clinical Outcomes ◽

Osteochondral Allograft ◽

Cartilage Defects ◽

Osteochondral Defects ◽

Focal Lesions ◽

Cartilage Restoration ◽

Intervention Patient ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

AbstractLarge, focal articular cartilage defects of the knee (> 4 cm2) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.

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The Importance of Staging Arthroscopy for Chondral Defects of the Knee

The Journal of Knee Surgery ◽

10.1055/s-0040-1713126 ◽

2020 ◽

Author(s):

Hytham S. Salem ◽

Zaira S. Chaudhry ◽

Ludovico Lucenti ◽

Bradford S. Tucker ◽

Kevin B. Freedman

Keyword(s):

Articular Surface ◽

Treatment Plan ◽

Meniscal Repair ◽

Osteochondral Allograft ◽

Mri Findings ◽

Allograft Transplantation ◽

Chondral Defects ◽

Cartilage Restoration ◽

Chondrocyte Implantation ◽

Magnetic Resonance Imaging Mri

AbstractThis study aims to evaluate the role of staging arthroscopy in the diagnosis of knee chondral defects and subsequent surgical planning prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and meniscus allograft transplantation (MAT). All patients who underwent staging arthroscopy prior to ACI, OCA, or MAT at our institution from 2005 to 2015 were identified. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, magnetic resonance imaging (MRI) findings and previous operative records. Operative records of the subsequent staging arthroscopy procedure were reviewed to document the proposed treatment plan after arthroscopy. All changes in treatment plan following staging arthroscopy were recorded. Univariate analyses were performed to identify any significant predictors for likelihood to change. A total of 98 patients were included in our analysis. A change in surgical plan was made following arthroscopy in 36 patients (36.7%). Fourteen patients (14.3%) were found to have additional defects that warranted cartilage restoration surgery. In 15 patients (15.3%), at least one defect that was originally thought to warrant cartilage restoration surgery was found to be amenable to debridement alone. The surgical plan was changed from ACI to OCA in four cases (4.1%) and OCA to ACI in one case (1%). A previously proposed MAT was deemed unwarranted in one case (1%), and a planned meniscal repair was changed to MAT in another (1%). Patient age, sex, and the affected knee compartment were not predictors for a change in surgical plan. Body mass index (BMI) was significantly higher in patients who had a change in surgical plan (29.5 kg/m2) compared with those who did not (26.5 kg/m2). A change in surgical plan was more likely to occur for trochlear lesions (46.4%) compared with other articular surface lesions (p = 0.008). The results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects and meniscal deficiency, particularly those with trochlear cartilage lesions.

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Stretching for Recovery from Groin Pain or Injury in Athletes: A Critical and Systematic Review

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk6030073 ◽

2021 ◽

Vol 6 (3) ◽

pp. 73

Author(s):

José Afonso ◽

João Gustavo Claudino ◽

Hélder Fonseca ◽

Daniel Moreira-Gonçalves ◽

Victor Ferreira ◽

...

Keyword(s):

Groin Pain ◽

Case Series ◽

Return To Sport ◽

Return To Play ◽

Cochrane Library ◽

Eligibility Criteria ◽

Rehabilitation Protocols ◽

Recovery Protocols ◽

Meta Analyses ◽

Specific Contribution

Stretching is usually used as part of rehabilitation protocols for groin pain or injury, but its specific contribution to and within multimodal recovery protocols is unclear. Our goal was to systematically review the effects of stretching for the recovery from groin pain or injury. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, with eligibility criteria defined according to PICOS: (Participants) athletes with groin pain or injuries; (Interventions) interventions with stretching as the differentiating factor; (Comparators) comparators not applying stretching; (Outcomes) symptom remission or improvement and/or time to return to sport and/or return to play; (Study design) randomized controlled trials. Searches were performed on 26 March 2021, in CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science, with no limitations regarding language or date, and no filters. Of 117 retrieved results, 65 were duplicates and 49 were excluded at the screening stage. The three articles eligible for full-text analysis failed to comply with one or more inclusion criteria (participants, intervention and/or comparators). We then went beyond the protocol and searched for non-randomized trials and case series, but no intervention was found where stretching was the differentiating factor. We found no trials specifically assessing the effects of stretching on recovery or improvement of groin pain or injury in athletes. Currently, the efficacy of these interventions is unknown, and more research is warranted.

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Current solutions for the treatment of chronic articular cartilage defects in the knee

EFORT Open Reviews ◽

10.1302/2058-5241.5.190031 ◽

2020 ◽

Vol 5 (3) ◽

pp. 156-163 ◽

Cited By ~ 6

Author(s):

Mukai Chimutengwende-Gordon ◽

James Donaldson ◽

George Bentley

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Osteochondral Allograft ◽

Cartilage Defects ◽

Rehabilitation Period ◽

Chondrocyte Implantation ◽

Osteochondral Autograft Transfer ◽

Articular Cartilage Defects

Chondral and osteochondral defects in the knee are common and may lead to degenerative joint disease if treated inappropriately. Conventional treatments such as microfracture often result in fibrocartilage formation and are associated with inferior results. Additionally, microfracture is generally unsuitable for the treatment of defects larger than 2–4 cm2. The osteochondral autograft transfer system (OATS) has been shown to produce superior clinical outcomes to microfracture but is technically difficult and may be associated with donor-site morbidity. Osteochondral allograft use is limited by graft availability and failure of cartilage incorporation is an issue. Autologous chondrocyte implantation (ACI) has been shown to result in repair with hyaline-like cartilage but involves a two-stage procedure and is relatively expensive. Rehabilitation after ACI takes 12 months, which is inconvenient and not feasible for athletic patients. Newer methods to regenerate cartilage include autologous stem cell transplantation, which may be performed as a single-stage procedure, can have a shorter rehabilitation period and is less expensive than ACI. Longer-term studies of these methods are needed. Cite this article: EFORT Open Rev 2020;5:156-163. DOI: 10.1302/2058-5241.5.190031

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Return to Play After Medial Patellofemoral Ligament Reconstruction: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546520947044 ◽

2020 ◽

pp. 036354652094704

Author(s):

Amit K. Manjunath ◽

Eoghan T. Hurley ◽

Laith M. Jazrawi ◽

Eric J. Strauss

Keyword(s):

Systematic Review ◽

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Mpfl Reconstruction ◽

Return To Play ◽

Rate Of Return ◽

Cochrane Library ◽

Inclusion Criteria ◽

Recurrent Instability ◽

Recurrent Patellar Instability

Background: Medial patellofemoral ligament (MPFL) reconstruction is being performed more frequently in athletes experiencing recurrent patellar instability. Purpose/Hypothesis: The purpose was to systematically review the evidence in the orthopaedic sports medicine literature to determine both the rate and timing of return to play after MPFL reconstruction and the rate of further patellar instability. Our hypothesis was that there would be a high rate of return to play after MPFL reconstruction. Study Design: Systematic review. Methods: A systematic literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which utilized EMBASE, MEDLINE, and the Cochrane Library databases. Inclusion criteria for literature included clinical studies reporting on return to play after MPFL reconstruction. Rate of return to play, level of return, timing of return, rate of recurrent instability, and patient-reported outcomes were evaluated. Statistical analysis was performed using SPSS. Results: Our review found 27 studies including 1278 patients meeting our inclusion criteria. The majority of patients were women (58%), and the total group had a mean age of 22.0 years and a mean follow-up of 39.3 months. The overall rate of return to play was 85.1%, with 68.3% returning to the same level of play. The average time to return to play was 7.0 months postoperatively. The rate of recurrent instability events following reconstruction was 5.4%. There was an improvement in both mean visual analog scale, pain scores (preoperative: 4.3, postoperative: 1.6) and Tegner activity scores (preoperative: 4.8, postoperative: 5.5). Conclusion: The overall rate of return to play was high after MPFL reconstruction for the treatment of recurrent patellar instability. However, a relatively high percentage of those patients were unable to return to their preoperative level of sport. Additionally, there was a moderate time taken to return to play, at approximately 7 months after the procedure.

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