Urgent warning signs — calf pain or swelling, fever, the knee locking — are one tap away, always.Something feel wrong?Red flags →
AFTER MACI
The evidence

Every source this site rests on

From any source, see everything on the site that leans on it — that is what makes this checkable by a sceptical reader or a clinician. Amber ▲ marks evidence from a different operation than yours.

Cited on the site — 60
E1Ebert JR et al. 10-Year Clinical and MRI-Based Outcomes of an RCT Evaluating a 6-Week Return to Full Weightbearing After MACI. OJSM 202541 claims lean on it
Evidence strength 4 of 5
E2Ebert JR et al. An accelerated 6-week return to full weight bearing after MACI results in good clinical outcomes to 5 years. KSSTA 202110 claims lean on it
Evidence strength 4 of 5
E3Kraeutler MJ et al. Is Delayed Weightbearing After MACI Associated With Better Outcomes? OJSM 201818 claims lean on it
Evidence strength 4 of 5
E4Edwards PK, Ackland T, Ebert JR. Clinical rehabilitation guidelines for MACI on the tibiofemoral joint. JOSPT 2014;44(2):102-1993 claims lean on it
Evidence strength 3 of 5
E5Flanigan DC, Sherman SL, Chilelli B, et al. Consensus on rehabilitation guidelines among orthopedic surgeons in the United States following use of third-generation articular cartilage repair (MACI). Cartilage 2021;13(1 Suppl):1782S-1790S. Vericel-sponsored; two sponsor employees are co-authors. Milestone timing only — no exercise dose of any kind. Full text held143 claims lean on it
Evidence strength 2 of 5
E6Dhillon J, Fasulo SM, Kraeutler MJ, Belk JW, McCulloch PC, Scillia AJ. The Most Common Rehabilitation Protocol After MACT Is Immediate Partial Weight-Bearing and CPM. Arthroscopy, Sports Medicine, and Rehabilitation 2022;4(6):e2115-2350 claims lean on it
Evidence strength 4 of 5
E133Ebert JR, Fallon M, Smith A, Janes GC, Wood DJ. Prospective clinical and radiologic evaluation of patellofemoral matrix-induced autologous chondrocyte implantation. AJSM 2015;43(6):1362-72. Carries a week-by-week patellofemoral rehabilitation protocol (its Table 2) — the first located anywhere in this corpus. 19 of 47 had concurrent tibial tubercle transfer10 claims lean on it
Evidence strength 2 of 5
E134Pietschmann MF, Horng A, Glaser C, et al. [Post-treatment rehabilitation after autologous chondrocyte implantation: state of the art and recommendations of the Clinical Tissue Regeneration Study Group of the DGU and DGOOC]. Unfallchirurg 2014;117(3):235-41. German. Location-specific recommendation with separate femoral and retropatellar protocols (its Infoboxes 1 and 2). Member survey → published recommendations; self-designates level IVb3 claims lean on it
Evidence strength 1 of 5
E55Lorentz SG et al. Rehabilitation and return-to-play following knee cartilage injuries — an international Delphi consensus statement. J Cartilage Joint Preserv 2024 (investigator-initiated, surgeon-only panel; 5 of 11 rehab/RTP statements failed to reach consensus)1 claim lean on it
Evidence strength 2 of 5
E154Reinold MM, Wilk KE, Macrina LC, Dugas JR, Cain EL. Current concepts in the rehabilitation following articular cartilage repair procedures in the knee. JOSPT 2006;36(10):774-794. Full text held3 claims lean on it▲ different surgeryE157Ebert JR, Joss B, Ackland T. Accelerated Rehabilitation Guidelines for the Knee Using MACI (matrix-induced autologous chondrocyte implant). Hollywood Functional Rehabilitation Clinic with Genzyme Biosurgery; 2010. 36 pp. Non-peer-reviewed handout produced with manufacturer involvement, not a study. Full text held1 claim lean on it
Evidence strength 3 of 5
E201Ohio State University Sports Medicine. Autologous Chondrocyte Implantation (ACI) Clinical Practice Guideline. Updated April 2023. Institutional guideline, not a study. Full text held1 claim lean on it
Evidence strength 3 of 5
E221Jørgensen SL, Bohn MB, Aagaard P, Mechlenburg I. Blood flow restriction added to usual care exercise in patients with early weight bearing restrictions after cartilage or meniscus repair in the knee joint: a feasibility study. J Exp Orthop 2022;9(1):101. Publishes both a restricted-flow protocol and a conventional strength dose. Full text held3 claims lean on it
Evidence strength 3 of 5
E279Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev 2016;3:CD005523. No included trial compared one aquatic dose against another — every comparison is aquatic versus control. The PDF extracts per character; quote the `.HTML-FULLTEXT` file. Full text held1 claim lean on it▲ different surgeryE289Mass General Brigham Sports Medicine. Rehabilitation Protocol for ACI Trochlea Patella. Institutional protocol, not a study. Patellofemoral-specific and states no exercise dose of any kind — its only minute figures are continuous passive motion at 6-8 hours a day in 2 hour blocks, its quad sets are an exercise name carrying no count, its pool walking is undosed, and the word daily appears only in activities of daily living. Retrieved by the owner 2026-09-07 after every automated route redirected to a generic page. Full text held3 claims lean on it
Evidence strength 3 of 5
E292Rehabilitation Guide for Patella and Trochlea MACI Repair. Published on timspalding.com under the page title "Warwickshire Knee Surgeon- Cartilage and Knee Specialist". The page names no author — its author metadata reads websupport, and a name taken from the domain or a search result is not a name taken from the document. A surgeon's patient guide, not a study. Doses static quadriceps work, a lag-free straight-leg raise and calf pumping through weeks 1–6, and builds flexion to 120° by six weeks. Retrieved 2026-09-11. Full text held6 claims lean on it
Evidence strength 3 of 5
E293Rehabilitation Guide for Femoral Condyle MACI Repair. Published on timspalding.com under the same page title as the row above, and likewise names no author. A surgeon's patient guide, not a study. The femoral-condyle companion, with the same static quadriceps, straight-leg raise and calf-pumping wording, touch weight bearing to two weeks, and passive flexion built to 120° by six weeks. Retrieved 2026-09-11. Full text held1 claim lean on it
Evidence strength 3 of 5
E7Saris D et al. Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up (SUMMIT). AJSM 20144 claims lean on it
Evidence strength 4 of 5
E8Brittberg M et al. …Five-Year Follow-up (SUMMIT Extension). AJSM 20181 claim lean on it
Evidence strength 4 of 5
E10Clinical and Radiological Outcomes at ≥10-Year Follow-up After MACI in the Patellofemoral Joint14 claims lean on it
Evidence strength 2 of 5
E11Mistry H et al. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 20173 claims lean on it
Evidence strength 4 of 5
E12Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation (HD-ACI). Bioengineering 20231 claim lean on it
Evidence strength 1 of 5
E14Ebert JR et al. Isokinetic knee extensor strength deficit following MACI. Clin Biomech 201233 claims lean on it
Evidence strength 2 of 5
E15Ebert JR et al. Prior procedures, graft location, preoperative physical health, postoperative strength and graft integrity are associated with 10-year clinical outcome after MACI. KSSTA 202620 claims lean on it
Evidence strength 2 of 5
E16Ebert JR, Janes GC, Wood DJ. Post-operative sport participation and satisfaction with return to activity after MACI. IJSPT 20203 claims lean on it
Evidence strength 3 of 5
E17Ebert JR et al. Factors predictive of outcome 5 years after MACI in the tibiofemoral joint. AJSM 20136 claims lean on it
Evidence strength 3 of 5
E18Kunze KN et al. High Rate of Return to Sport for Athletes Undergoing Articular Cartilage Restoration Procedures for the Knee. AJSM 20259 claims lean on it
Evidence strength 4 of 5
E19Return to Sport in Professional Athletes After Cartilage Restoration Surgery of the Knee8 claims lean on it
Evidence strength 4 of 5
E20Return to Pivoting Sports after Cartilage Repair Surgery of the Knee: A Scoping Review7 claims lean on it
Evidence strength 1 of 5
E23Janacova V et al. Texture Analysis of Cartilage Repair Tissue Maturation. Cartilage 202610 claims lean on it
Evidence strength 3 of 5
E48Gobbi A et al. Patellofemoral full-thickness chondral defects treated with second-generation ACI: 5 years. AJSM 200916 claims lean on it
Evidence strength 2 of 5
E49Vasiliadis HS et al. Malalignment and cartilage lesions in the patellofemoral joint treated with ACI. KSSTA 20115 claims lean on it
Evidence strength 2 of 5
E24Harris JD et al. Failures, re-operations, and complications after autologous chondrocyte implantation. Osteoarthritis Cartilage 201114 claims lean on it
Evidence strength 4 of 5
E25Dave U et al. Deep vein thrombosis prophylaxis in patients who undergo knee arthroscopy. Knee Surg Relat Res 20247 claims lean on it▲ different surgeryE26Graham WC, Flanigan DC. Venous thromboembolism following arthroscopic knee surgery. Sports Med 20145 claims lean on it▲ different surgeryE27Okoroha KR et al. Effects of a Perioperative Blood Flow Restriction Therapy Program… OJSM 20238 claims lean on it▲ different surgeryE28Current Narrative Review — Application of Blood Flow Restriction Exercise in Clinical Knee Problems7 claims lean on it▲ different surgeryE29Effects of NMES After ACL Reconstruction on Quadriceps Strength, Function, and Patient-Oriented Outcomes. JOSPT 20105 claims lean on it▲ different surgeryE30Early NMES to improve quadriceps muscle strength after TKA5 claims lean on it▲ different surgeryE31Merkely G, Chisari E, Lola Rosso C, Lattermann C. Do NSAIDs Have a Deleterious Effect on Cartilage Repair? Cartilage 20211 claim lean on it▲ different surgeryE36Bullock GS et al. Kinesiophobia, Knee Self-Efficacy, and Fear Avoidance Beliefs in People with ACL Injury. Sports Med 20223 claims lean on it▲ different surgeryE37Zarzycki R et al. Female Athletes With Better Psychological Readiness Are at Higher Risk for Second ACL Injury. Sports Health 20245 claims lean on it▲ different surgeryE38Hambly K, Poomsalood S, Mundy E. Return to running following knee osteochondral repair using an anti-gravity treadmill. Phys Ther Sport 20173 claims lean on it
Evidence strength 1 of 5
E71Søreide E et al. The Effect of Limited Perioperative NSAIDs on Patients Undergoing ACL Reconstruction (the single human study in E31; neutral-to-favorable). AJSM 20161 claim lean on it▲ different surgeryE72Pountos I et al. NSAIDs inhibit chondrogenesis of human mesenchymal stem cells (sGAG −45% diclofenac / −55% ketorolac; osteogenesis unaffected). J Cell Mol Med 20111 claim lean on it▲ different surgeryE79McAlindon TE et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain (quarterly injections thinned cartilage; no pain benefit). JAMA 20171 claim lean on it▲ different surgeryE80Wernecke C et al. The Effect of Intra-articular Corticosteroids on Articular Cartilage: systematic review (dose- and time-dependent chondrotoxicity across agents). OJSM 20151 claim lean on it▲ different surgeryE81Cancienne JM et al. Corticosteroid injection within 4 weeks of knee arthroscopy raises 90-day infection risk several-fold. Arthroscopy 20191 claim lean on it▲ different surgeryE83Benzon HT et al. Multi-society clinical practice guideline on corticosteroid injections (silent on cartilage-repair patients — the documented guidance gap). Reg Anesth Pain Med 20261 claim lean on it▲ different surgeryE84Aggarwal A et al. Cryotherapy following total knee replacement (benefits "may be too small to justify its use"). Cochrane Database Syst Rev 20251 claim lean on it▲ different surgeryE86Su EP et al. A multi-center randomised trial of cryopneumatic therapy after TKA (509 vs 680 mg OME through 2 weeks; otherwise equivalent). JBJS Br 20121 claim lean on it▲ different surgeryE87Martin SS et al. Cryotherapy decreases intraarticular temperature after knee arthroscopy (7.1 °C difference at 60 min). AJSM 20011 claim lean on it▲ different surgeryE110Dammerer D et al. Effect of knee brace type on braking response time during automobile driving (ROM-limiting post-op brace impairs braking at every setting, including 0–90°). Arthroscopy 20151 claim lean on it▲ different surgeryE112DiSilvestro KJ et al. When Can I Drive After Orthopaedic Surgery? (figures are "a best-case scenario"; patients drive before measures normalize). CORR 20161 claim lean on it▲ different surgeryE39Nomura M et al. Disuse atrophy of articular cartilage can be restored by mechanical reloading in mice. Mol Biol Rep 20249 claims lean on it▲ different surgeryE41Guillén-García P et al. Increasing the Dose of Autologous Chondrocytes Improves Articular Cartilage Repair: Histological and Molecular Study in the Sheep Animal Model. Cartilage 20142 claims lean on it▲ different surgeryE42López-Alcorocho JM et al. Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation: Two-Year Follow-up. Cartilage 20182 claims lean on it
Evidence strength 2 of 5
E43López-Alcorocho JM et al. Clinical outcome and subchondral bone edema presence at two-year follow-up after high density autologous chondrocyte implantation treatment in the knee. Rev Esp Cir Ortop Traumatol (Engl Ed) 20191 claim lean on it
Evidence strength 2 of 5
E44Guillén-Vicente I et al. Intermediate-Term Clinical Outcomes of High-Density Autologous Chondrocyte Implantation in Patients with Concomitant Anterior Cruciate Ligament Reconstruction and Focal Chondral Lesions. Cartilage 20251 claim lean on it
Evidence strength 2 of 5
E50Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res 20071 claim lean on it
Evidence strength 2 of 5
In the evidence base, not cited — 157

Two kinds, and this list does not distinguish them: sources collected for content still being written, and sources read for the author’s own decisions — supplements, peptides — which are written up at cartilageguide.com rather than here. Both stay listed so the base is auditable in full, not just the parts this site leans on.

E135Della Villa S, Kon E, Filardo G, et al. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? AJSM 2010;38(1):68-77. Compares an intensive 4-phase protocol against phase-1-only controls — the nearest thing to a rehabilitation comparison in this literature, and not randomizedProspective cohort with control group (level 3) · n = 31 athletes / 34 controls · 5 yr follow-up
Evidence strength 3 of 5
E136Karnes JM, Harris JD, Griesser MJ, Flanigan DC. Continuous passive motion following cartilage surgery: does a common protocol exist? Phys Sportsmed 2013;41(4):53-63. The CPM-specific review E6 cites as its own reference 42. Its finding is about how CPM was reported, not about how much it varied: "there was a lack of consistent standardized reporting of postoperative CPM protocols, specifically timing, duration, and frequency"Systematic review · n = 107 studies / 5723 pts / 6612 defects (1569 patellofemoral; ACI 61%, microfracture 23%, OCA 10%, OAT 6%)▲ different surgeryE138Hambly K, Bobic V, Wondrasch B, Van Assche D, Marlovits S. Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. AJSM 2006;34(6):1020-38. The review of record for rehabilitation after this operation. Carries a five-phase protocol with progression criteria; names modalities and states no set or repetition count at any phase. Full text heldNarrative review + published protocol
Evidence strength 1 of 5
E139Vogt S, Angele P, Arnold M, Brehme K, Cotic M, Haasper C, Hinterwimmer S, Imhoff AB, Petersen W, Salzmann G, Steinwachs M, Venjakob A, Mayr HO. Practice in rehabilitation after cartilage therapy: an expert survey. Arch Orthop Trauma Surg 2013;133(3):311-20. Practice-pattern evidence with real denominators; states no sets, repetitions or per-exercise frequency. Full text heldCross-sectional survey of expert surgeons · n = 246 of 304 instructors (80.9%)
Evidence strength 2 of 5
E145Gunhamn T, Pojskic H, Augustsson SR. Knee extensor training in patients with patellofemoral pain: a systematic review and synthesis. Front Rehabil Sci 2025;6:1641054. Full text heldSystematic review with descriptive synthesis · n = 79 studies (61 RCTs, 18 non-randomised)▲ different surgeryE147Ebert JR, Fallon M, Robertson WB, Lloyd DG, Zheng M, Wood DJ, Ackland T. Radiological assessment of accelerated versus traditional approaches to postoperative rehabilitation following matrix-induced autologous chondrocyte implantation. Cartilage 2011;2(1):60-72. Full text heldRCT · n = 70 randomised; 69 analysed · 24 months follow-up
Evidence strength 4 of 5
E149Cole BJ, Kercher JS, Wilk KE, Macrina LC, Reinold MM. Rehabilitation following microfracture of the knee. Cartilage 2010;1(2):96-107. Full text heldClinical commentary (narrative review)
Evidence strength 1 of 5
E150Hurley ET, Davey MS, Jamal MS, Manjunath AK, Alaia MJ, Strauss EJ. Return-to-play and rehabilitation protocols following cartilage restoration procedures of the knee: a systematic review. Cartilage 2021;13(1 Suppl):907S-914S. Reports when protocols start things, never how much. Full text heldSystematic review (PRISMA) · n = 179 studies (116 level IV)▲ different surgeryE151Husted RS, Troelsen A, Thorborg K, Rathleff MS, Husted H, Bandholm T. Efficacy of pre-operative quadriceps strength training on knee-extensor strength before and shortly following total knee arthroplasty: protocol for a randomized, dose-response trial (the QUADX-1 trial). Trials 2018;19:47. Protocol only, no outcome data. Full text heldRCT protocol · n = 140 planned · 12 weeks follow-up▲ different surgeryE152Steib S, Rahlf AL, Pfeifer K, Zech A. Dose-response relationship of neuromuscular training for injury prevention in youth athletes: a meta-analysis. Front Physiol 2017;8:920. Full text heldSystematic review and meta-analysis · n = 16 trials · 6–40 week interventions follow-up▲ different surgeryE153Sekome K, Maddocks S. The short-term effects of hydrotherapy on pain and self-perceived functional status in individuals living with osteoarthritis of the knee joint. S Afr J Physiother 2019;75(1):476. Full text heldProspective single-arm pre-post study, no control · n = 18 · 4 weeks follow-up▲ different surgeryE156Vericel. MACI (autologous cultured chondrocytes on porcine collagen membrane) Rehabilitation Manual. Manufacturer document, not a study. Full text heldClinical practice guideline (manufacturer)
Evidence strength 3 of 5
E158Hambly K, Poomsalood S, Mundy E, Stephens D. Return to running following knee osteochondral repair using an anti-gravity treadmill. University of Kent. Conference poster; no journal, DOI, PMID or year printed. Distinct from E38, which is the Phys Ther Sport 2017 case report of the same title. Full text heldCase report (conference poster), two patients · n = 2 · 8-week programme follow-up▲ different surgeryE159Ebert JR, Joss B, Ackland T. Accelerated Rehabilitation Guidelines for the Knee Using MACI: Exercise Companion Guide. Genzyme Corporation; 2011. 41 pp. Not a study. The companion the parent guideline defers dosing to; sets, reps and load are blank form fields. Full text heldClinical practice guideline (manufacturer-involved)
Evidence strength 3 of 5
E200Bade MJ, Stevens-Lapsley JE. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. JOSPT 2011;41(12):932-941. Full text heldProspective cohort with matched controls · n = 8 vs 8 · 52 weeks follow-up▲ different surgeryE202Redler LH. Knee Articular Cartilage MACI Patellofemoral Post-Operative Guidelines. Columbia Orthopedics. Single-surgeon protocol, not a study. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E203Vericel. MACI Tibiofemoral Joint Initial Rehabilitation Plan (16 pp). Manufacturer document, not a study. Full text heldClinical practice guideline (manufacturer)
Evidence strength 3 of 5
E204OrthoVirginia (Owusu-Akyaw K). Post-Operative Rehabilitation Guidelines: Cartilage Repair. Institutional protocol, not a study. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E205Vericel. MACI Knee Cartilage Repair: Rehabilitation Overview for Practices. Manufacturer document, not a study; its own text attributes the content to a Delphi panel of US surgeons. Full text heldClinical practice guideline (manufacturer) · n = Panel size not stated
Evidence strength 3 of 5
E206University of Virginia Sports Medicine. MACI Post-operative Rehabilitation Protocol. Institutional protocol, not a study. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E207Metzler AV. Knee: Matrix Autologous Chondrocyte Implantation (MACI) Rehab Protocol — Tibiofemoral Joint. Single-surgeon protocol, not a study. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E208Gherghel R, Onu I, Iordan DA, Antohe BA, Rezus II, Alexa O, Macovei LA, Rezus E. A new approach to postoperative rehabilitation following mosaicplasty and bone marrow aspiration concentrate (BMAC) augmentation. Biomedicines 2024;12(6):1164. Randomises rehabilitation duration rather than surgery. Full text heldRCT, three arms · n = 37 (10 / 15 / 12)
Evidence strength 4 of 5
E209Pierson SR, Silverman RM, Knapp B, Brophy RH. Rehabilitation and return to play protocols following osteochondral autograft and allograft transplantation for knee chondral lesions in athletic populations. Curr Rev Musculoskelet Med 2026;19(1):40. Full text heldNarrative review
Evidence strength 1 of 5
E210Crowley SG, Pedersen A, Fortney TA, Swindell HW, Saltzman BM, Popkin CA, Trofa DP. Rehabilitation variability following osteochondral autograft and allograft transplantation of the knee. Cartilage 2022;13(2). Quantifies disagreement between published protocols. Full text heldCross-sectional review of published protocols · n = 35 protocols from 16 of 155 programmes
Evidence strength 2 of 5
E214Patel S, Amirhekmat A, Le R, Williams RJ, Wang D. Osteochondral allograft transplantation in professional athletes: rehabilitation and return to play. Int J Sports Phys Ther 2021;16:941-958. Full text heldNarrative review
Evidence strength 1 of 5
E215Wagner KR, Kaiser JT, DeFroda SF, Meeker ZD, Cole BJ. Rehabilitation, restrictions, and return to sport after cartilage procedures. Arthrosc Sports Med Rehabil 2022;4(1):e115. Full text heldNarrative review▲ different surgeryE216American College of Sports Medicine. Position stand: progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009;41(3):687-708. Superseded by the current ACSM stand (E141); held as historical context and must not be cited as current guidance. Full text heldConsensus position stand · n = Expert panel, no participants▲ different surgeryE217Haber T, Bennell KL, Metcalf BR, McManus F, Lawford BJ, Lamb KE, Button P, Hinman RS. FREquency of strength home exercises for knee osteoarthritis pain: protocol for the FRESH non-inferiority randomised controlled trial. Osteoarthritis Cartilage Open 2026;8(3):100816. Protocol only, no outcome data. Full text heldRCT protocol · n = 178 planned · 3 months follow-up▲ different surgeryE219Haber DB, Logan CA, Murphy CP, Sanchez A, LaPrade RF, Provencher MT. Osteochondral allograft transplantation for the knee: post-operative rehabilitation. Int J Sports Phys Ther 2019;14(3):487-499. Carries an on-population set-and-rep prescription — its Appendix 1 is a page image, so quote the `.ALT-EXTRACTION` file. Full text heldNarrative review with protocol tables
Evidence strength 1 of 5
E220Randsborg PH, Brinchmann J, Løken S, Hanvold HA, Aae TF, Årøen A. Focal cartilage defects in the knee — a randomized controlled trial comparing autologous chondrocyte implantation with arthroscopic debridement. BMC Musculoskelet Disord 2016;17:117. Publishes a per-day range-of-motion repetition count. Full text heldRCT · n = 80 planned · 2 years follow-up
Evidence strength 4 of 5
E222Toonstra JL, Howell D, English RA, Lattermann C, Mattacola CG. The role of rehabilitation following autologous chondrocyte implantation: a retrospective chart review. Int J Sports Phys Ther 2013;8(5):670-679. Records actual rehabilitation contacts rather than a prescription. Full text heldRetrospective cohort (chart review) · n = 20 charts · 3, 6 and 12 months follow-up
Evidence strength 2 of 5
E223Hirschmüller A, Schoch W, Diemer F. Nachbehandlung nach knorpelregenerativen Eingriffen: Was müssen Chirurgen und Therapeuten wissen? Arthroskopie 2024. Physiotherapist co-authored, and it carries full dosing tables — repetitions, sets, rest, weekly frequency and intensity — for aftercare of cartilage-regenerative knee surgery. Open access. Full text heldClinical practice guideline
Evidence strength 3 of 5
E224Logerstedt DS, Scalzitti DA, Bennell KL, Hinman RS, Silvers-Granelli H, Ebert J, Hambly K, Carey JL, Snyder-Mackler L, Axe MJ, McDonough CM. Knee pain and mobility impairments: meniscal and articular cartilage lesions, revision 2018. JOSPT 2018;48(2):A1-A50. The physiotherapy clinical practice guideline for this population, and it states no dose — verified against the full text: no sets, no repetitions, no per-day or per-week frequency anywhere. Its only prescriptive number is a weight-bearing timeline. Full text heldClinical practice guideline
Evidence strength 3 of 5
E225Crowley SG, Swindell HW, Saltzman BM, Ahmad CS, Popkin CA, Trofa DP. Rehabilitation variability following femoral condyle and patellofemoral microfracture surgery of the knee. Cartilage 2021;13(1 Suppl):1801S-1813S. Measures the spread between published protocols rather than recommending one. Full text heldCross-sectional analysis of published protocols · n = 49 protocols from 18 institutions
Evidence strength 2 of 5
E226Diemer F. Nachbehandlung nach knorpelregenerativen Eingriffen. Qualitätskreis Knorpelgesellschaft (QKG); 2021. Companion to the Arthroskopie guideline above; gives criteria rather than doses and states that early-mobilisation parameters are insufficiently researched. Full text heldClinical practice guideline
Evidence strength 3 of 5
E227Tyler TF, Lung JY. Rehabilitation following osteochondral injury to the knee. Curr Rev Musculoskelet Med 2012;5(1):72-81. Carries range-of-motion ladders, depth caps by lesion location, and a per-day repetition count for wall slides. Full text heldNarrative review with protocol tables
Evidence strength 1 of 5
E228Patel S, Marrone W. The evolution of rehabilitation and return to sport following cartilage surgery. Int J Sports Phys Ther 2023;18(3). Not by Ebert despite being catalogued that way in places. Its stated MACI flexion progression conflicts with the German national recommendation; both are reported, neither reconciled. Full text heldClinical viewpoint (narrative review)
Evidence strength 1 of 5
E229Triana J, Li ZI, Rao N, Kingery MT, Strauss EJ. Return to play after knee articular cartilage restoration: surgical options, rehabilitation protocols, and performance outcomes. Curr Rev Musculoskelet Med 2023;16:575-586. Carries a procedure-by-procedure protocol table. Full text heldNarrative review with protocol table
Evidence strength 1 of 5
E230Coburn SL, Crossley KM, Kemp JL, Warden SJ, West TJ, Bruder AM, Mentiplay BF, Culvenor AG. Immediate and delayed effects of joint loading activities on knee and hip cartilage: a systematic review and meta-analysis. Sports Med Open 2023;9(1):56. The closest thing to a mechanobiology-informed loading dose; its pooled studies are observational repeated-measures rather than trials. Full text heldSystematic review and meta-analysis · n = 40 studies, 653 participants · Immediate to 48 hours follow-up▲ different surgeryE231Hirschmüller A, Baur H, Braun S, Kreuz PC, Südkamp NP, Niemeyer P. Rehabilitation after autologous chondrocyte implantation for isolated cartilage defects of the knee. AJSM 2011;39(12):2686-2696. Publishes sets, repetitions and intensity as a proportion of a one-repetition maximum, on-population. Extraction renders the degree sign as `/C176` and the multiplication sign as `3` — quote it byte-for-byte from the held file. Full text heldNarrative review with proposed protocol
Evidence strength 1 of 5
E232Niethammer TR, Aurich M, Brucker PU, Faber S, Diemer F, Pietschmann MF, Schoch W, Zinser W, Müller PE. Nachbehandlung nach Knorpeltherapie am Kniegelenk — eine Empfehlung der AG Klinische Geweberegeneration der DGOU. Z Orthop Unfall 2024;162(6):614-622. The current German national recommendation, surgeons and physiotherapists. German is the source language: quote the German, gloss separately. Full text heldDelphi consensus with evidence review · n = 34 panel members, 91.2% response
Evidence strength 2 of 5
E233Hirschmüller A, Schoch W, Baur H, Wondrasch B, Konstantinidis L, Südkamp NP, Niemeyer P. Rehabilitation before regenerative cartilage knee surgery: a new prehabilitation guideline based on the best available evidence. Arch Orthop Trauma Surg 2019;139(2):217-230. A complete exercise programme with sets, repetitions, intensity and weekly frequency — pre-operative, not post-operative. Full text heldClinical practice guideline with exercise programme · n = Tested in >50 patients (feasibility)
Evidence strength 3 of 5
E234Wondrasch B, Arøen A, Røtterud JH, Høysveen T, Bølstad K, Risberg MA. The feasibility of a 3-month active rehabilitation program for patients with knee full-thickness articular cartilage lesions: the Oslo Cartilage Active Rehabilitation and Education Study. JOSPT 2013;43(5):310-324. The fullest on-population dose specification held — sets, repetitions, load-progression rule and weekly frequency — and it states in terms that no resistance-training guidelines exist for this population. Full text heldProspective single-arm feasibility cohort · n = 48 enrolled, 44 completed · 3 months follow-up
Evidence strength 3 of 5
E250Fish DE, Krabak BJ, Johnson-Greene D, deLateur BJ. Optimal resistance training: comparison of DeLorme with Oxford techniques. Am J Phys Med Rehabil 2003;82(12):903-909. The only modern trial comparing the two loading orders, and it found no difference. Its subjects had knee surgery as an exclusion criterion. Full text heldRCT, evaluator-blind · n = 60 recruited, 50 analysed · 9 weeks follow-up▲ different surgeryE251Todd JS, Shurley JP, Todd TC. Thomas L. DeLorme and the science of progressive resistance exercise. J Strength Cond Res 2012;26(11):2913-2923. Held as the author-approved verbatim reprint in Iron Game History 12(4)/13(1), 2014. Reconstructs the 1945 to 1948 revision from primary documents. Page scans, read by OCR — quote the `.ocr.txt`. Full text heldNarrative historical scholarship▲ different surgeryE252DeLorme TL, Watkins AL. Technics of progressive resistance exercise. Arch Phys Med Rehabil 1948;29(5):263-273. The origin of three sets of ten. Note the title is Technics; most citing literature misprints it as Techniques. The paper states of itself that it makes no reference to results obtained. Page scans, read by OCR — the fractions ½ and ¾ resolve only in the `.ocr.txt`. Full text heldTechnical review (methods paper) · n = None — no patient series▲ different surgeryE253DeLorme TL. Restoration of muscle power by heavy-resistance exercises. J Bone Joint Surg 1945;27(4):645-667. The original scheme — seven to ten sets of ten — later revised downward. Page scans, read by OCR. Full text heldUncontrolled clinical case series · n = 300 cases · Ten months in several patients follow-up▲ different surgeryE254DeLorme TL. Heavy resistance exercises. Arch Phys Med 1946;27(10):607-630. The same 300-case series as the 1945 paper. Contraindicates the exercises in chondromalacia accompanied by pain, swelling and fluid where open operation has not been performed. Page scans, read by OCR. Full text heldUncontrolled clinical case series · n = 300 cases · Ten months in several patients follow-up▲ different surgeryE255National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226; 19 October 2022. States no exercise dose at all — its therapeutic-exercise recommendations name no sets, repetitions, frequency or intensity. Full text heldClinical practice guideline▲ different surgeryE256Royal Dutch Society for Physical Therapy (KNGF). Guideline: osteoarthritis of the hip-knee — conservative, pre-operative and post-operative treatment. V-06/2018, English edition. Carries an explicit strength prescription, and its own notes state it is adopted from a professional-body recommendation for rheumatic disorders rather than derived from its evidence review. Full text heldClinical practice guideline, GRADE-based▲ different surgeryE270Lawford BJ, Hall M, Hinman RS, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2024;12:CD004376. The largest single body of evidence on whether exercise dose changes outcomes. The PDF extracts per character and cannot satisfy a verbatim quote check — quote the `.HTML-FULLTEXT` file. Full text heldSystematic review and meta-analysis · n = 139 trials, 12,468 participants▲ different surgeryE271Torstensen TA, Østerås H, Grooten WJA, Äng BO. High- versus low-dose medical exercise therapy for knee osteoarthritis: protocol. BMJ Open 2018;8(5). Carries the verbatim dose arms of the trial itself, which is paywalled and not held. Full text heldRCT protocol · n = 189 planned · 12 weeks follow-up▲ different surgeryE272Bruvoll M, Torstensen TA, Conradsson DM, Äng BO, Østerås H. Feasibility of high dose medical exercise therapy in patients with long-term symptomatic knee osteoarthritis. Physiother Theory Pract 2021. The only open document showing whether the high-dose arm is actually deliverable; its conclusion is that it often is not. Full text heldProspective single-arm feasibility study · n = 29 enrolled, 26 completed · 12 weeks follow-up▲ different surgeryE273Husted RS, Troelsen A, Husted H, Grønfeldt BM, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. Knee-extensor strength, symptoms, and need for surgery after two, four, or six exercise sessions per week (the QUADX-1 trial). Held as the open medRxiv preprint of Osteoarthritis Cartilage 2022;30(7):973-986. Randomised exercise frequency directly and found no dose-response. Full text heldRCT, three arms, dose-response · n = 140 · 12 months follow-up▲ different surgeryE274Juhl C, Christensen R, Roos EM, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol 2014;66(3):622-636. Found weekly frequency did matter while intensity and session duration did not — read alongside the Cochrane review, which tested total sessions rather than sessions per week. Full text heldSystematic review with meta-regression · n = 48 RCTs▲ different surgeryE275Young JL. The influence of physical therapy use on outcomes for musculoskeletal disorders of the lower extremity. PhD thesis, University of Newcastle, 2021. Chapter 3 is the published Young et al. JOSPT 2018;48(3):146-161 review reproduced in full with permission, the journal version being unobtainable. Found dosing parameters that did track effect size. Full text heldSystematic review, within a thesis · n = 45 studies
Evidence strength 4 of 5
E276de Wit L et al. Association between prescribed dosage of resistance exercise and change in pain and physical function in knee osteoarthritis: a systematic review with meta-regression. Musculoskeletal Care 2025. Full text heldSystematic review with meta-regression · n = 14 trials▲ different surgeryE277Yang et al. Optimal resistance training strategies for knee osteoarthritis symptom relief: a systematic review and network meta-analysis. BMC Musculoskelet Disord 2025. Models an optimum in weekly repetitions and percentage of one-repetition maximum — neither of which this site publishes. Full text heldSystematic review and network meta-analysis · n = 46 RCTs, 3,463 participants▲ different surgeryE278Lenssen AF, et al. Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: a randomised controlled trial. BMC Musculoskelet Disord 2006;7:71. The only post-operative knee trial that has ever varied times per day, and it found no difference. Full text heldRCT · n = 43 · 3 months follow-up▲ different surgeryE280Franco MR, Morelhão PK, de Carvalho A, Pinto RZ. Aquatic exercise for the treatment of hip and knee osteoarthritis. Phys Ther 2017;97(7):693-710. A commentary on the Cochrane aquatic review, not a primary study — commonly miscited as a separate trial. Full text heldCommentary on a systematic review▲ different surgeryE281Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee osteoarthritis: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord 2010;11:126. Publishes sets, repetitions and session length for a neuromuscular programme. Full text heldProspective feasibility study · n = 76▲ different surgeryE282Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D): evidence-based education and supervised neuromuscular exercise. BMC Musculoskelet Disord 2017;18:72. An implemented national programme; publishes session count and length but no sets or repetitions. Full text heldProspective cohort, programme description▲ different surgeryE283Mithoefer K, Hambly K, Logerstedt D, Ricci M, Silvers H, Della Villa S. Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete. JOSPT 2012;42(3):254-273. Carries a per-day range-of-motion dose and attributes it to E138, which contains neither the figure nor any per-day frequency — absence verified against the held PDF 2026-09-07. States no sets and no repetitions anywhere in its 20 pages. Full text heldNarrative review (journal clinical commentary)▲ different surgeryE284Slabaugh MA. Articular Cartilage Repair Rehabilitation Protocol. Mercy Medical Center, Baltimore. Single-surgeon protocol, not a study. Carries an on-population set-and-repetition prescription — a first-set count then further sets to muscle failure — in a maturation phase its own text continues past six months. Full text heldClinical practice guideline (institutional)▲ different surgeryE285Bents RT. Knee — Microfracture / OATS / Cartilage Procedures Post-Op Rehab Protocol. Paragon Orthopedic Center, Grants Pass OR, revised March 2020. Single-surgeon protocol, not a study. Doses passive motion per day and leaves quadriceps work undosed in the same list. Full text heldClinical practice guideline (institutional)▲ different surgeryE286Rehabilitation Protocol: Autologous Chondrocyte Implantation (ACI) — Patellofemoral Joint, Large Lesion Patella or Trochlea with Tibial Tubercle Transfer. TheSportsSurgeon.com, Dallas. Institutional protocol, not a study; no author named on the document. Patellofemoral-specific and states no exercise dose of any kind. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E287Elisabeth-Krankenhaus Leipzig. Nachbehandlung Knorpelzelltransplantation MACT/ACT (2022). German institutional aftercare scheme, not a study. Phase table by compartment; states no exercise dose. Records that active knee extension is contraindicated for patellofemoral cartilage-cell transplantation. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E288Ortho+ Franken (Wohlgefahrt M). Nachbehandlung zur Knorpeltransplantation (2023). German patient-information document, not a study. States no exercise dose. Held so the search is recorded as run rather than repeated. Full text heldClinical practice guideline (institutional, patient-facing)
Evidence strength 3 of 5
E290Mass General Brigham Sports Medicine. Rehabilitation Protocol for ACI Femoral Condyle. Institutional protocol, not a study. The condyle companion to the row above and silent in the same way — minutes only for continuous passive motion, no sets, no repetitions, no per-day or per-week exercise frequency. Retrieved by the owner 2026-09-07. Full text heldClinical practice guideline (institutional)
Evidence strength 3 of 5
E291Debecker N, Luyten M, Vandenabeele F, Bellemans J. The effect of anti-gravity training after meniscal or chondral injury in the knee. Acta Orthop Belg 2020;86(3):422-433. The only systematic review of this device in this population, and it states no rehabilitation dose — no weekly frequency, no session count; its minute and session figures are the testing protocols of included biomechanics studies. Searched PubMed and Web of Science only, and does not include the 2018 case report. Full text heldSystematic review · n = Limited number of studies, usually moderate quality (authors' own assessment)▲ different surgeryE294Discharge Instructions – Autologous Chondrocyte Transplant (MACI), Dr. Wulf, August 2019, hosted at tcomn.com. A clinic's patient discharge sheet, not a study; no practice name appears in the extracted text. Lists a fever over 101 degrees for more than 24 hours among what to report to the surgeon, and sets continuous passive motion goals of 110° by six weeks and full range by twelve. Retrieved 2026-09-11. Full text heldClinical practice guideline (institutional, patient-facing)
Evidence strength 3 of 5
E295UK HealthCare, Orthopaedic Surgery & Sports Medicine. Post-Operative (After Surgery) General Instructions. Published among the resources of the UK Center for Cartilage Repair and Restoration. A clinic's patient instructions, not a study. Tells patients to call with any temperature over 101.0 degrees. Retrieved 2026-09-11. Full text heldClinical practice guideline (institutional, patient-facing)
Evidence strength 3 of 5
E9Matrix-assisted autologous chondrocyte transplantation is effective at mid/long-term for knee lesions. 2024Systematic review + meta-analysis · n = 19 studies / 1,031 pts · to 10 yr follow-up
Evidence strength 4 of 5
E13FDA MACI package insertRegulatory labeling
Evidence strength 2 of 5
E56Wang AS et al. Minimum 10-Year Outcomes of MACI in the Knee: A Systematic Review. AJSM 2024Systematic review · n = 168 pts / 188 defects · ≥10 yr follow-up
Evidence strength 4 of 5
E57Milliron EM et al. Use of MACI in the United States: Expanded Experience over 5,000 Cases. Cartilage 2025 (descriptive; heavy Vericel COIs disclosed)Retrospective cohort (registry) · n = 5,000 pts / 5,198 knees
Evidence strength 2 of 5
E58Valisena S et al. Microfracture, AMIC, OAT and ACI for knee chondral defects: network meta-analysis of RCTs. EFORT Open Rev 2024Network meta-analysis of RCTs · n = 19 RCTs
Evidence strength 4 of 5
E59Nassar JE et al. ACI, MACI, OAT and OCA improve knee function and pain, with no between-technique differences. KSSTA 2025Systematic review + meta-analysis · n = 47 studies / 1,993 pts · 57.2 mo mean follow-up
Evidence strength 4 of 5
E60Bumberger A et al. Increased risk of reoperation after ACI in female patients and individuals with previous surgeries (KnorpelRegister DGOU). KSSTA 2023Retrospective cohort (registry, time-to-event) · n = 2,039 (1,359 with ≥24 mo) · ≥24 mo follow-up
Evidence strength 2 of 5
E61Pasic N et al. Rate of Conversion to MACI After a Biopsy: A Multisurgeon Study (26.1% converted to restoration). OJSM 2023Case series · n = 46 biopsied
Evidence strength 2 of 5
E62Vicioso C et al. Online information on MACI knee surgery: analysis and opportunities to improve patient education and decision-making. Knee 2026Cross-sectional web-content analysis · n = 1,620 web entries
Evidence strength 2 of 5
E21Moon HS et al. MOCART 2.0 score of 60 or greater at 1 year predicts favourable clinical outcomes. KSSTA 2025Retrospective cohort + ROC · n = 86 · ≥1 yr follow-up
Evidence strength 2 of 5
E22Goller SS et al. MOCART 2.0 for retropatellar autologous chondrocyte transplantation. Knee 2022Prospective imaging cohort · n = 38 · 12 mo follow-up
Evidence strength 3 of 5
E63Ebert JR et al. 10-Year Prospective Clinical and Radiological Evaluation After MACI and Comparison of Tibiofemoral and Patellofemoral Graft Outcomes. AJSM 2024Prospective case series · n = 168 reviewed / 151 grafts on MRI · 10 yr follow-up
Evidence strength 2 of 5
E64Weishorn J et al. Factors Influencing Long-term Outcomes After MACI (BMI 20–29, MOCART 2.0, prior surgeries independently associated with long-term KOOS). AJSM 2024Case series + multivariable regression · n = 103 · 8.1 yr mean (5–11.9) follow-up
Evidence strength 2 of 5
E65Jaiswal et al. Smoking and outcome of ACI for full-thickness chondral defects (graft failures only in smokers; dose–response r=−0.65). JBJS Br 2009Retrospective cohort (case-control) · n = 114 · 2 yr follow-up
Evidence strength 2 of 5
E66Betz et al. Smoking and MACI outcomes in the German Cartilage Registry (null for KOOS/pain/satisfaction to 24 mo). J Knee Surg 2023Retrospective cohort (registry) · n = 281 knees · 24 mo follow-up
Evidence strength 2 of 5
E67Jungmann et al. Risk factors for reintervention after ACI (neither BMI nor smoking retained in multivariable model). AJSM 2012Retrospective cohort + multivariable regression · n = 413 · ~4.4 yr follow-up
Evidence strength 2 of 5
E68Merkely, Ackermann & Gomoll. Hypertension is an independent predictor of graft failure after ACI (OR 3.73). Cartilage 2021Retrospective cohort + regression · n = 368 (209 ACI / 159 OCA) · ≥2 yr follow-up
Evidence strength 2 of 5
E69Jin X et al. Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain (null in vitamin-D-deficient patients). JAMA 2016RCT · n = 413 · 2 yr follow-up▲ different surgeryE70Bogunovic L et al. Hypovitaminosis D in patients scheduled for orthopaedic surgery (52% of sports-medicine service abnormal). JBJS Am 2010Retrospective cohort (chart review) · n = 723▲ different surgeryE140Eichinger M, Henninger B, Petry B, Schuster P, Herbst E, Wagner M, Rosenberger R, Mayr R. Treatment of cartilage defects in the patellofemoral joint with matrix-associated autologous chondrocyte implantation effectively improves pain, function, and radiological outcomes after 5-7 years. Arch Orthop Trauma Surg 2024;144:1655-65. Full text held; states no rehabilitation doseRetrospective case series · 5-7 yr follow-up
Evidence strength 2 of 5
E142Roos EM, Engelhart L, Ranstam J, Anderson AF, Irrgang JJ, Marx RG, Tegner Y, Davis AM. ICRS Recommendation Document: patient-reported outcome instruments for use in patients with articular cartilage defects. Cartilage 2011;2(2):122-36. The field's own recommendation on which outcome instrument to use, co-authored by the authors of KOOS, the IKDC subjective form and the Tegner scale. Full text heldNarrative review — a recommendation document from a non-systematic literature search
Evidence strength 1 of 5
E137Patterson SD, Hughes L, Warmington S, et al. Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety. Front Physiol 2019;10:533. Narrative review, not a consensus — it describes itself as "a current research informed guide" and the word consensus does not appear in it; carries an explicit prescription-model table (its Table 1). Full text held in `sources/`Narrative review▲ different surgeryE141Currier BS, D'Souza AC, Fiatarone Singh MA, Lowisz CV, Rawson ES, Schoenfeld BJ, Smith-Ryan AE, Steen JP, Thomas GA, Triplett NT, Washington TA, Werner TJ, Phillips SM. American College of Sports Medicine Position Stand. Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Med Sci Sports Exerc 58(4):851-72. Full text heldPosition stand; overview of systematic reviews▲ different surgeryE32Sajjad Khawaja A et al. Non-steroidal anti-inflammatory drugs influence cartilage healing. Knee 2025Animal experimental · n = 36 rats▲ different surgeryE33Howard EE et al. Skeletal Muscle Disuse Atrophy and the Rehabilitative Role of Protein. Adv Nutr 2020Narrative review▲ different surgeryE34Dirks ML et al. Skeletal muscle disuse atrophy is not attenuated by dietary protein supplementation in healthy older men. J Nutr 2014RCT · n = 23▲ different surgeryE35Lim C et al. Fortetropin supplementation prevents the rise in myostatin but not disuse-induced atrophy. PLoS One 2023RCT · n = 24▲ different surgeryE73Pountos I et al. NSAIDs inhibit bone healing through downregulation of TGF-β3 during endochondral ossification (PGE2 replenishment does not rescue). Injury 2021In vitro · n = 10 donors▲ different surgeryE74Sok D et al. NSAID Use Reduces the Therapeutic Efficacy of MSC Therapy in a Rat Osteoarthritis Model (post-injection and continuous naproxen blunt the effect; pre-treatment minimal). AJSM 2022Animal▲ different surgeryE75Schug SA. Do NSAIDs Really Interfere with Healing after Surgery? J Clin Med 2021Narrative review▲ different surgeryE76Komargodski R et al. NSAID use and bone healing: umbrella review with reconstructed meta-analysis (nonunion OR 1.56; use ≤14 days not associated). JAAOS 2026Umbrella review + meta-analysis · n = 16 reviews / 38 studies▲ different surgeryE77Salis Z et al. Long-term NSAID use and knee osteoarthritis: multi-cohort study (structural null; worse pain/disability and TKR OR 3.13 — confounding by indication flagged by authors). Sci Rep 2024Prospective cohort · n = 4,197 / 8,394 knees▲ different surgeryE78NO PAin Investigators (Gazendam et al.). Opioid-sparing analgesia after outpatient knee/shoulder arthroscopy (naproxen-based protocol; median 0 vs 40 mg OME). JAMA 2022RCT · n = 200▲ different surgeryE82Jayaram P et al. Chondrotoxic Effects of Local Anesthetics on Human Knee Articular Cartilage: systematic review (steroid co-administration worsens toxicity). PM R 2019Systematic review (in vitro) · n = 16 studies▲ different surgeryE116Huskisson EC et al. Effects of antiinflammatory drugs on the progression of osteoarthritis of the knee (LINK study: indomethacin 40/85 vs placebo 19/85 deteriorated, P=.009; tiaprofenic acid null; 54% attrition, sequential interim analysis). J Rheumatol 1995RCT · n = 812 randomized / 376 evaluable▲ different surgeryE117Rashad S et al. Effect of non-steroidal anti-inflammatory drugs on the course of osteoarthritis (strong vs weak prostaglandin inhibitor; indomethacin hips progressed faster, reached arthroplasty sooner). Lancet 1989Prospective controlled trial · n = 105▲ different surgeryE118Reijman M et al. Diclofenac >180 days and radiologic OA progression in the Rotterdam Study (hip OR 2.4, knee OR 3.2, both CIs bounded at 1.0; comparator = short-term users). Arthritis Rheum 2005Prospective cohort · n = 2,514 hips / 874 knees▲ different surgeryE119Mazzuca SA, Brandt KD et al. Knee pain reduces joint space width in conventional standing radiographs (analgesia widens apparent JSW by 0.20 mm — a bias toward false NSAID protection larger than most reported effects). Arthritis Rheum 2002Prospective methodological radiographic study · n = 15▲ different surgeryE120Ding C, Cicuttini F, Jones G. Do NSAIDs affect longitudinal changes in knee cartilage volume and defects? (conventional NSAIDs: defect ORs 3.1/2.6; COX-2 inhibitors protective, OR 0.4; n=21 exposed drives the harm ORs). Am J Med 2009Prospective cohort (MRI morphometry) · n = 395▲ different surgeryE121Simic M et al. Clinical risk factors and radiographic OA progression among people with knee pain (baseline NSAID use aOR 2.05, adjusted for K/L, JSW and alignment; blinded assessors). Arthritis Res Ther 2021Prospective cohort (nested in a randomized trial) · n = 498▲ different surgeryE122Kreutzinger V et al. Limited effects of NSAIDs on imaging outcomes in OA (new-user matched design; cartilage WORMS progression slower in users — the peer-reviewed reversal of the unpublished RSNA 2022 abstract by the same group). BMC Musculoskelet Disord 2025Prospective cohort (new-user, matched) · n = 142 + 707▲ different surgeryE123Salis Z. Long-term NSAID use and radiographic hip OA over 4–5 years (null across incidence, progression, and nine features; progression arm underpowered). Osteoarthr Cartil Open 2024Prospective cohort · n = 6,164 hips▲ different surgeryE124Palmoski MJ, Brandt KD. Proteoglycan depletion, rather than fibrillation, determines the effects of salicylate and indomethacin on OA cartilage (susceptibility is a property of matrix depletion, not the drug). Arthritis Rheum 1985Animal ex vivo▲ different surgeryE125Palmoski MJ, Brandt KD. Effects of salicylate and indomethacin on intact canine knee cartilage ex vivo (slice-culture effects largely vanish; intra-cartilage drug concentration ~1,000-fold below medium). Arthritis Rheum 1984Animal ex vivo▲ different surgeryE126Collier S, Ghosh P. NSAIDs and proteoglycan synthesis: explant vs monolayer (effects only at 50–100 µg/mL; culture model reverses conclusions). Biochem Pharmacol 1991In vitro▲ different surgeryE127Dingle JT. The effects of NSAID on the matrix of human articular cartilages (the sparing/neutral/destructive classification, ~830 cartilages, with the author's own extrapolation caveat; aspirin neutral in human tissue). Z Rheumatol 1999In vitro · n = ~830 cartilages▲ different surgeryE128de Boer TN et al. Chondroprotective effect of selective COX-2 inhibition: human cartilage after 4 weeks of in vivo treatment (celecoxib beneficial; indomethacin trend non-significant). Osteoarthr Cartil 2009In vitro analysis of human cartilage after 4 weeks of in vivo dosing▲ different surgeryE129El Hajjaji H et al. Celecoxib improves hyaluronan and proteoglycan metabolism in human OA cartilage; diclofenac neutral at therapeutic concentrations. J Rheumatol 2003In vitro▲ different surgeryE130Chang JK et al. NSAIDs and proliferation/death in cultured chondrocytes (apoptosis at stated-therapeutic concentrations; COX-2-selectives largely spared; fetal rat monolayer). Toxicology 2006In vitro▲ different surgeryE131Mastbergen SC et al. Celecoxib in the canine groove model (in vivo structural null despite adequate joint exposure; authors' own "analgesia → increased loading" hypothesis). Rheumatology 2006Animal · n = 24▲ different surgeryE132Ding C. Do NSAIDs affect the progression of osteoarthritis? ("even the same NSAID had reverse effects on articular cartilage in different studies"). Inflammation 2002Narrative review▲ different surgeryE85Daszkiewicz et al. Cryotherapy after ACL reconstruction: systematic review of RCTs (inconsistent; no consensus). Adv Clin Exp Med 2026Systematic review of RCTs · n = 9 RCTs / 509▲ different surgeryE111Giannoudis VP et al. Driving after knee arthroplasty: systematic review and meta-analysis (no significant total-BRT recovery until 3 months; RT unreliable). Knee 2021Systematic review + meta-analysis · n = 12 studies / 368▲ different surgeryE113Waton A et al. Immobilisation of the knee and ankle and its impact on drivers' braking times (casts and locked brace prolong braking; ~3 m extra stopping distance at 30 mph). JBJS Br 2011Prospective controlled simulator experiment · n = 23▲ different surgeryE114Chihuri S, Li G. Use of prescription opioids and motor vehicle crashes: meta-analysis (crash involvement OR 2.29). Accid Anal Prev 2017Meta-analysis · n = 15 studies▲ different surgeryE115Salem HS et al. Return to Driving After ACL Reconstruction (right 4–6 wk, left 2–3 wk; manual transmission erases the left-side advantage). OJSM 2021Systematic review · n = 5 studies▲ different surgeryE53Vasireddi N et al. Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review. HSS J 2025Systematic review · n = 36 studies▲ different surgeryE54Gwyer D et al. Gastric pentadecapeptide BPC 157 and its role in accelerating musculoskeletal soft tissue healing. Cell Tissue Res 2019Narrative review▲ different surgeryE88Shaw G et al. Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis (PINP surrogate; proof-of-concept). Am J Clin Nutr 2017RCT (crossover) · n = 8▲ different surgeryE89Lis DM, Baar K. Effects of Different Vitamin C-Enriched Collagen Derivatives on Collagen Synthesis (own-lab replication: no treatment reached significance; delivery equivalent across forms). IJSNEM 2019RCT (crossover) · n = 10▲ different surgeryE90Zdzieblik D et al. Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides (FORTIGEL; CRI-affiliated authors). Appl Physiol Nutr Metab 2017RCT · n = 139▲ different surgeryE91Zdzieblik D et al. Specific Bioactive Collagen Peptides and Knee Joint Discomfort in Young Physically Active Adults (part-funded by GELITA; per-protocol analysis; authors state results do not transfer to other collagen products). Nutrients 2021RCT · n = 218 randomized / 180 analyzed▲ different surgeryE92Praet SFE et al. Specific Collagen Peptides with Calf-Strengthening Exercises in Achilles Tendinopathy (TENDOFORTE; GELITA-supported pilot). Nutrients 2019RCT (crossover) · n = 20▲ different surgeryE93Jerger S et al. Specific collagen peptides increase patellar tendon cross-sectional area with 14 weeks of knee-extensor training (stiffness/strength equal between groups). Eur J Sport Sci 2023RCT · n = 50▲ different surgeryE94McAlindon TE et al. Change in knee osteoarthritis cartilage detected by dGEMRIC following collagen hydrolysate (imaging signal, no clinical difference; GELITA-funded pilot). Osteoarthr Cartil 2011Pilot RCT · n = 30▲ different surgeryE95Liang CW et al. Efficacy and safety of collagen derivatives for osteoarthritis: trial sequential meta-analysis (pain SMD −0.35; the most independent positive synthesis). Osteoarthr Cartil 2024Trial-sequential meta-analysis · n = 35 RCTs / 3,165▲ different surgeryE96Holwerda AM, van Loon LJC. The impact of collagen protein ingestion on musculoskeletal connective tissue remodeling (the critical counter-argument). Nutr Rev 2022Narrative review▲ different surgeryE97Aussieker T et al. Collagen ingestion during recovery from exercise does not increase muscle connective protein synthesis (independent tracer/biopsy null). Med Sci Sports Exerc 2023RCT (stable-isotope tracer) · n = 45▲ different surgeryE98Alcock RD, Shaw G, Burke LM. Bone broth unlikely to provide reliable concentrations of collagen precursors (measured amino-acid analysis vs 20 g supplement). IJSNEM 2019In vitro food composition analysis▲ different surgeryE99DePhillipo NN et al. Efficacy of Vitamin C Supplementation After Musculoskeletal Injuries: systematic review (strong preclinical rationale; no adequate human post-injury trials). OJSM 2018Systematic review▲ different surgeryE100Akintoye E et al. Fish Oil and Perioperative Bleeding (OPERA RCT: no increased major bleeding at aggressive perioperative dosing; fewer transfusions). Circ Cardiovasc Qual Outcomes 2018Secondary analysis of RCT · n = 1,516▲ different surgeryE101Laslett LL et al. Krill Oil for Knee Osteoarthritis (KARAOKE: decisively null in a synovitis-enriched population). JAMA 2024RCT · n = 262▲ different surgeryE102Hill CL et al. Fish oil in knee osteoarthritis: low-dose vs high-dose (no dose-response; no cartilage-volume benefit). Ann Rheum Dis 2016RCT · n = 202▲ different surgeryE103Stonehouse W et al. Krill oil and osteoarthritic knee pain: 6-month RCT (significant but below-MCID improvements; no inflammatory-marker change). Am J Clin Nutr 2022RCT · n = 235▲ different surgeryE104Deng W et al. Omega-3 fatty acids for arthritis pain: meta-analysis (pain SMD −0.29; predates the null KARAOKE trial). J Orthop Surg Res 2023Systematic review + meta-analysis · n = 9 RCTs / 2,070▲ different surgeryE105Curtis CL et al. n-3 fatty acids modulate catabolic factors in articular cartilage degradation. J Biol Chem 2000In vitro explant study▲ different surgeryE106Hespel P et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy (no prevention during casting; faster CSA/power recovery during rehab). J Physiol 2001RCT · n = 22▲ different surgeryE107Backx EMP et al. Creatine loading does not preserve muscle mass or strength during leg immobilization (null even in confirmed responders). Sports Med 2017RCT · n = 30▲ different surgeryE108Tyler TF et al. Creatine supplementation and strength recovery after ACL reconstruction (null at 6/12 weeks and 6 months). AJSM 2004RCT · n = 60▲ different surgeryE109Chilibeck PD et al. Creatine during resistance training and lean tissue mass in older adults: meta-analysis (+1.37 kg lean mass vs training alone). Open Access J Sports Med 2017Systematic review + meta-analysis · n = 22 RCTs / 721▲ different surgeryE40Wu Y et al. Improved Articular Cartilage Repair With Stratified Zonal Chondrocyte Implantation. AJSM 2025Controlled laboratory (porcine)▲ different surgeryE45Guillén-García P et al. Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation (HD-ACI). Bioengineering (Basel) 2023Narrative review
Evidence strength 1 of 5
E46López-Alcorocho JM et al. Study of Telomere Length in Preimplanted Cultured Chondrocytes. Cartilage 2019In vitro laboratory study (with clinical follow-up) · n = 3 · 2 yr follow-up▲ different surgeryE47Guillén-Vicente I et al. Comparing telomere lengths in chondrocytes from intact cartilage and those isolated from loose bodies. Tissue Cell 2025In vitro laboratory study · n = 3▲ different surgeryE52Della Villa F et al. Rehabilitation after Articular Cartilage Repair of the Knee in the Football PlayerNarrative review
Evidence strength 1 of 5