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Purpose: Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques.Methods: A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model.Results: Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total, 2549 patients were included (1756 M, 793 F) with an average age of 35 years and follow-up of 47 months. Return to sport at some level was 76 % overall, with highest rates of return after OAT (93 %), followed by OCA (88 %), ACI (82 %), and MFX (58 %). Osteochondral autograft transfer showed the fastest return to sports (5.2 ± 1.8 months) compared to 9.1 ± 2.2 months for MFX, 9.6 ± 3.0 months for OCA and 11.8 ± 3.8 months for ACI (P < 0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport.Conclusion: In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76 % return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: It is unknown what causes donor site morbidity following the osteochondral autograft transfer procedure or how donor sites heal. Contact pressure and edge loading at donor sites may play a role in the healing process. It was hypothesized that an artificially created osteochondral defect in a weightbearing area of an ovine femoral condyle will cause osseous bridging of the defect from the upper edges, resulting in incomplete and irregular repair of the subchondral bone plate. Methods: To simulate edge loading, large osteochondral defects were created in the most unfavourable weightbearing area of 24 ovine femoral condyles. After killing at 3 and 6 months, osteochondral defects were histologically and histomorphometrically evaluated with specific attention to subchondral bone healing and subchondral bone plate restoration. Results: Osteochondral defect healing showed progressive osseous defect bridging by sclerotic circumferential bone apposition. Unfilled area decreased significantly from 3 to 6 months ( P = 0.004), whereas bone content increased (n.s.). Complete but irregular subchondral bone plate restoration occurred in ten animals. In fourteen animals, an incomplete subchondral bone plate was found. Further common findings included cavitary lesion formation, degenerative cartilage changes and cartilage and subchondral bone collapse. Conclusions: Osteochondral defect healing starts with subchondral bone plate restoration. However, after 6 months, incomplete or irregular subchondral bone plate restoration and subsequent failure of osteochondral defect closure is common. Graft harvesting in the osteochondral autograft transfer procedure must be viewed critically, as similar changes are also present in humans. Level of evidence: Prognostic study, Level III. [ABSTRACT FROM AUTHOR]