Evidence / Sources / E3
Kraeutler MJ et al. Is Delayed Weightbearing After MACI Associated With Better Outcomes? OJSM 2018
Evidence strength 4 of 5
Systematic review of RCTs · n = 7 pubs / 3 samples / 136 pts · mean 2.5 yr follow-upMACI ITSELFFull text →What it can tell you
What happens when you pool the randomized weight-bearing evidence: no advantage to delayed weight-bearing across three trial samples, and the bathroom-scale method for hitting a prescribed load percentage.
What it cannot
Which protocol is best — the pooled groups used different lesion sizes, scaffolds, and outcome instruments, a limitation the authors state themselves.
Everything on this site that leans on E3 — 18 claims
Stage II · Protection [tibiofemoral]“Tibiofemoral protocols restrict weight-bearing and free up motion — the inverse of patellofemoral. Studied protocols graduated weight over 6–9 weeks while allowing early, comparati…”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…”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) · Gates“Each rung of the weight-bearing ladder carried without a swelling response before the next”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…”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…”What we don't know · № 03“Exercise selection, sets, reps and intensity have never been randomized at any stage.”What we don't know · № 20“Nobody has compared how fast to progress *within* a phase — only how fast to reach full weight-bearing.”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 6 (tibiofemoral)“The only intermediate rung any randomized arm used inside this window. The canonical ladder does not contain it — that one steps 40% at week four to 60% at week six — so this is on…”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 10 (tibiofemoral)“Four weeks of toe-touch, then a fortnight at 20%, then half, then full here. This is the long end of what has been tested — and at two and a half years it failed no more often than…”Week ruler · week 11 (tibiofemoral)“The same pooled review's other slow schedule takes a different route to nearly the same place — five straight weeks at a fifth of body weight, then full, with no intermediate rung …”Hard limits · stage 1 (tibiofemoral)“Never more weight than the percentage you were given”Hard limits · stage 2 (tibiofemoral)“Full weight is a clearance, not a date”Why this · Why you are on crutches for weeks, and bending freely the whole time“On the tibiofemoral side weight was graduated over roughly six to nine weeks in the studied protocols, while range of motion started immediately and progressed comparatively freely…”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…”
Read it like a sceptic
Seven publications but only three underlying patient samples (136 patients) — the review is smaller than its citation count suggests.
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.