Evidence / Sources / E15

Ebert 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 2026

Retrospective case series + regression · n = 143 · 10 yr follow-upMACI ITSELFFull text →

What it can tell you

Which factors travelled with good 10-year outcomes in 143 patients: fewer prior procedures, tibiofemoral location, better pre-operative health, greater post-operative quadriceps strength, better graft integrity on MRI.

What it cannot

Causation, in any direction. Level IV: whether strong quadriceps protect knees or good knees permit strong quadriceps is exactly what a retrospective regression cannot say — and this site says so at every point of use.

Everything on this site that leans on E15 — 20 claims

Stage I · Before“Pre-operative physical and mental health predicted 5-year outcomes, and pre-operative physical health was still in the 10-year regression. Condition before surgery is one of only t…”Stage I · Before [patellofemoral]“Set expectations against the right cohort: patellofemoral repairs recover pain and daily function well, but sport and quality-of-life scores run lower than femoral condyle repairs …”Stage I · Before · Questions“Between the biopsy and the implantation, what do you want me doing — and what's the actual booking interval?”Stage IV · Strength“By month three the studied protocols have restored full weight and near-full motion; what remains is the quadriceps, and it matters more than it feels like it should. Post-operativ…”Stage V · Impact [patellofemoral]“At two years, 85% of a mixed MACI cohort were satisfied with recreational return but only 66% with sport — and tibiofemoral location predicted better sport scores than patellofemor…”Stage VI · Long horizon“Greater knee extensor strength contributed to higher 10-year quality-of-life scores. This is association, not causation — a Level IV series cannot say whether strong quads protect …”Stage VI · Long horizon [patellofemoral]“Strength work through years two to five treated as part of the operation, not its aftermath — the decline window in patellar and multifocal series is exactly when most people stop.”Program · Stage VI (patellofemoral)“Extensor strength work, indefinitely — Association, not causation — a Level IV series cannot say whether strong quads protect knees or good knees permit strong quads. It is still t…”Program · Stage VI (patellofemoral) · Gates“Strength work through years two to five treated as part of the operation, not its aftermath”Program · Stage VI (tibiofemoral)“Extensor strength work, indefinitely — Association, not causation — a Level IV series cannot say whether strong quads protect knees or good knees permit strong quads. It is still t…”Program · Stage VI (tibiofemoral) · Gates“Strength and impact work continuing past year one as part of the operation, not its aftermath”Exercise Library · Straight-leg raise, no lag · Evidence for this movement“That the quadriceps deficit is worth this much of the stage — measurable at five years; tracks with ten-year quality of life”Exercise Library · Strength measurement“Knee extensor torque at forty-five degrees of flexion was significantly reduced at all test speeds five years after the operation, while peak torque differences did not reach signi…”Exercise Library · Maintenance strength“The authors who found extensor deficits persisting five years after the operation concluded that the early supervised rehabilitation phase is not sufficient to restore long-term kn…”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 · № 12“The interval between biopsy and implantation has no published guidance, and prehabilitation has never been trialled.”Why this · Why the quadriceps gets the priority, and why a lagging raise ends the set“Knee extensor deficits were still measurable five years after implantation, concentrated at around 45° of flexion, and greater quadriceps strength tracked with better ten-year knee…”Why this · Why the strength gets measured here rather than estimated“Greater post-operative quadriceps strength travelled with better ten-year knee-related quality of life, making it one of only two things about the long-term outcome still open to c…”Why this · Why the strength gets measured, and why work comes back by demand rather than by date“Knee extensor torque was significantly reduced at every test speed five years after implantation, concentrated at around 45° of flexion, and greater post-operative quadriceps stren…”Why this · Why a yearly measurement against a fixed reference“Angle-specific extensor deficits were still measurable five years after the operation, and greater quadriceps strength travelled with better ten-year knee-related quality of life.”

Read it like a sceptic

Retrospective, single group, and the strength–outcome association is the site's central argument — treat the enthusiasm with proportional care.

Population

MACI, knee

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.