Evidence / Sources / E1
Ebert JR et al. 10-Year Clinical and MRI-Based Outcomes of an RCT Evaluating a 6-Week Return to Full Weightbearing After MACI. OJSM 2025
What it can tell you
Whether an accelerated 6-week return to full weight-bearing after tibiofemoral MACI held up — at ten years, clinical and MRI outcomes were as good as the conservative 8-week arm. The single best rehabilitation study this field has.
What it cannot
Nothing about patellofemoral lesions — all grafts were femoral condyle. Nothing about faster-than-6-weeks: six weeks is the fastest protocol ever tested, and extrapolating downward is not supported. Load outside the clinic was unmeasured, by the authors' own limitations.
Everything on this site that leans on E1 — 41 claims
Stage I · Before [tibiofemoral]“Femoral condyle cohorts are the best-studied reference in this field: randomized to their weight-bearing speed, followed to ten years, pain scores near ceiling. Worth knowing befor…”Stage II · Protection [tibiofemoral]“Progression toward partial then full weight through the studied 6–9 week window without swelling response.”Stage III · Loading [tibiofemoral]“Tibiofemoral readers in this window are still progressing off crutches toward full weight — the studied protocols reached full weight-bearing between 6 and 9 weeks (the accelerated…”Stage III · Loading [tibiofemoral]“Full weight-bearing with a normal gait pattern and confidence walking without crutches — the consensus panel ranked gait quality above pain reduction as the milestone.”Stage V · Impact [tibiofemoral]“The randomized femoral condyle cohort reached limb-symmetry values near 100% on strength and hop testing and held KOOS Sport/Rec near 77–78 out to ten years — but note how they got…”Stage VI · Long horizon [tibiofemoral]“The randomized femoral condyle cohort is the durability benchmark: KOOS Pain around 88 at ten years, no MRI parameter declining significantly across the decade, graft failure 11.8%…”Stage VI · Long horizon [tibiofemoral]“A yearly strength check against an absolute reference, not just the other leg — symmetry can overestimate function because the uninvolved limb detrains too, a limitation the cohort…”Program · Stage II (patellofemoral)“Ankle pumps and early mobilization — Active ankle movement was standard care in the randomized cohort. The clot-specific evidence is from knee arthroscopy generally.”Program · Stage II (tibiofemoral)“Weight-bearing, the bottom of the ladder — An electronic bathroom scale is the published teaching method: load the leg on the scale until the number matches, and remember the feel.…”Program · Stage II (tibiofemoral)“Ankle pumps and early mobilization — Active ankle movement was standard care in the randomized cohort. The clot-specific evidence is from knee arthroscopy generally.”Program · Stage III (tibiofemoral)“Weight-bearing, up the ladder — A bathroom scale is the published method for hitting a prescribed percentage: load the leg on the scale until the number matches, and remember the f…”Program · Stage III (tibiofemoral) · Gates“Full weight-bearing with a normal gait pattern and confidence walking without crutches”Program · Stage V (patellofemoral)“Heavy strength work, continued — Impact weeks are not a reason to stop lifting. The strength base is what the new load lands on.”Program · Stage V (tibiofemoral)“Heavy strength work, continued — Impact weeks are not a reason to stop lifting. The strength base is what the new load lands on.”Program · Stage VI (patellofemoral)“Annual strength review, against a fixed reference — The randomized cohort that stayed durable held limb symmetry near 100% for a decade — and its authors still cautioned that symme…”Program · Stage VI (patellofemoral) · Gates“A yearly strength check against an absolute reference, not just the other leg”Program · Stage VI (tibiofemoral)“Annual strength review, against a fixed reference — The ten-year randomized cohort is femoral condyle — the one place the benchmark population matches a tibiofemoral reader exactly…”Program · Stage VI (tibiofemoral)“Year two, on purpose — Knowing late change is possible is a reason to be seen when the knee changes, not a reason to expect it.”Program · Stage VI (tibiofemoral) · Gates“A yearly strength check against an absolute reference, not just the other leg”Exercise Library · The weight-bearing ladder“Weight-bearing progression is the only rehabilitation variable randomized in cartilage repair: seven publications representing three unique patient samples and 136 patients, all fe…”Exercise Library · The weight-bearing ladder“An accelerated arm reaching full weight-bearing at 6 weeks matched an 8-week arm on every patient-reported and functional outcome to 10 years, with graft signal intensity on MRI fa…”Exercise Library · Ankle pumps and early mobilization“Active ankle movement and early mobilization were standard care in the randomized cartilage-repair cohort; the clot-risk evidence itself comes from knee arthroscopy generally rathe…”Exercise Library · Heavy strength work, continued“The randomized cohort that maintained its outcomes to ten years held limb symmetry near parity across extensor, flexor and hop testing, and its authors concluded that early supervi…”Exercise Library · Annual strength review“Angle-specific extensor deficits were still measurable five years after the operation, and the randomized cohort that maintained its outcomes to ten years held limb symmetry near p…”Exercise Library · Second-year vigilance“Across a large systematic review of implantation failures the mean time to graft failure was around twenty-two months, repair tissue was still maturing measurably on imaging at twe…”Benchmarks · KOOS Pain“88.4 / 88.1 at 10 years — Randomized femoral condyle cohort, 6- vs 8-week weight-bearing arms”Benchmarks · KOOS Sport/Rec“78.0 / 76.8 at 10 years — Randomized femoral condyle cohort, 6- vs 8-week weight-bearing arms”Benchmarks · KOOS Quality of Life“69.4 / 69.3 at 10 years — Randomized femoral condyle cohort, 6- vs 8-week weight-bearing arms”Benchmarks · LSI extensor, flexor, and hop tests“99.1–103.8% across tests at 10 years — Randomized femoral condyle cohort”What we don't know · № 08“No cohort measured what patients actually did after discharge — so whether continued training causes durable outcomes is unanswerable.”What we don't know · № 10“The strength cut-offs in use were validated in ligament reconstruction, and limb symmetry can overestimate function.”passive-flexion · how to measure it“The position and the instrument are the ones the ten-year weight-bearing trial used, which assessed knee range supine with a long-arm goniometer. That trial measured active range; …”HD-ACI (ICC) · the population this site's program was built on“The randomised trial that produced the accelerated weight-bearing timeline enrolled femoral condyle lesions only — twenty-seven medial and ten lateral — averaging 3.15 cm² in one a…”Week ruler · week 6 (tibiofemoral)“The faster of the two randomized schedules reaches full weight here, and matched the slower one on every clinical measure out to ten years. It is the fastest schedule anyone has te…”Week ruler · week 8 (tibiofemoral)“The slower randomized schedule arrives here, and the canonical protocol puts full weight indoors at the same week on surgeon clearance. Two sources, one week, arrived at independen…”Week ruler · week 12 (tibiofemoral)“Both arms of the ten-year randomized trial were seen twice a week until this point, and then were not. Everything after this week — in the trial and on this site — is you, unsuperv…”Hard limits · stage 2 (tibiofemoral)“Full weight is a clearance, not a date”Why this · Why weight is the one variable anybody actually tested“The randomized rehabilitation evidence in this field is three unique patient samples totalling 136 patients, every one of them a femoral condyle lesion, and all three asked essenti…”Why this · Why faster was never worse — and why six weeks is still the floor“An accelerated arm reaching full weight-bearing at six weeks matched a conservative arm on every clinical measure out to ten years, and its repair tissue scored slightly better on …”Why this · Why year two is the one to watch“The mean time to graft failure across a large pooled series was around twenty-two months, repair tissue was still measurably changing on imaging at twenty-four, and the randomized …”Why this · Why a yearly measurement against a fixed reference“The randomized cohort that held its outcomes to ten years also held limb symmetry near parity across every strength and hop measure — and angle-specific extensor deficits were stil…”
Read it like a sceptic
n=35 patients — powered as a follow-up of a small RCT, not a definitive trial.
Both arms received structured, supervised rehabilitation; this compares two schedules, not rehab vs none.
Population
MACI, femoral condyle
Selection policy
Sources enter the registry through docs/research — the evidence table records design, population, and size for every entry, and pages cannot cite anything outside it.