Return to Sport After Articular Cartilage Repair in Athletes’ Knees: A Systematic Review

Purpose: To perform a literature review to determine which surgical interventions allow athletes to return to their pre-injury level of competition.


  • Microfracture was the most frequently performed procedure (n=529), followed by ACI (n=259), osteochondral autograft (n=139) and osteochondral allograft (n=43)
  • Each technique has been shown to reduce pain and improve function scores in athletes but microfracture patients were the least likely to return to sport with a decline in their athletic performance and the highest re-injury rate
  • Time to return to play varies across techniques: microfracture (3-6 months), OATS (6-9 months), OCA (7-13 months) and ACI (10-18 months)
  • Patients younger than 30 were more likely to return to their preinjury level of competition
  • Patients experiencing symptoms for less than 12 months pre-operatively tended to have better outcomes and a quicker return to sport
  • Ability to return to high impact sports correlated to a graft smaller than 2 cm2. Defect size was found to be largest in OCA patients
  • Overall, the rate of return to sports was 78% amongst athletic populations. OATs yielded the best results, followed by OCA then ACI and microfracture.

Take Away:  Across all techniques, athletes with a better prognosis after surgery were younger, had a shorter preoperative duration of symptoms, underwent no previous surgical interventions, had a more rigorous rehabilitation protocol and had smaller cartilage lesions.

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Authors: Andrew B. Campbell, MD, Miguel Pineda, BS, Joshua D. Harris, MD and David C. Flanigan, MD

Published: Arthroscopy. 2016 Apr;32(4):651-68.e1.

Institution: The Ohio State University Division of Sports Medicine Cartilage Repair Center

Study Design: Systematic Review