Cutting maneuvers performed without adequate planning may increase the risk of noncontact knee ligament injury due to the increased external varus/valgus and internal/external rotation moments applied to the knee. These results are probably due to the small amount of time to make appropriate postural adjustments before performance of the task, such as the position of the foot on the ground relative to the body center of mass. Subsequently, training for the game situation should involve drills that familiarize players with making unanticipated changes of direction. Practice sessions should also incorporate plyometrics and should focus on better interpretation of visual cues to increase the time available to preplan a movement.

Compared with running, the potential for increased ligament loading during sidestepping and crossover cutting maneuvers is a result of the large increase in varus/valgus and internal/external rotation moments rather than any change in the external flexion moment. The combined external moments applied to the knee joint during stance phase of the cutting tasks are believed to place the ACL and collateral ligaments at risk of injury, particularly at knee flexion angles between 0 degrees and 40 degrees, if appropriate muscle activation strategies are not used to counter these moments.

The outcomes of this randomized trial demonstrate a safe and effective accelerated rehabilitation protocol as well as a regimen that provides comparable, if not superior, clinical outcomes to patients throughout the postoperative timeline.

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Objective:To determine the safety and efficacy of “accelerated” postoperative load-bearing rehabilitation following matrix-induced autologous chondrocyte implantation (MACI).Design:A randomized controlled study design was used to investigate clinical outcomes in 70 patients following MACI, in conjunction with either accelerated or traditional approaches to postoperative weight-bearing (WB) rehabilitation. Both interventions sought to protect the implant for an initial period and then incrementally increase WB. Under the accelerated protocol, patients reached full WB at 8 weeks postsurgery, compared to 11 weeks for the traditional group. Clinical outcomes were assessed presurgery and at 3, 6, 12, and 24 months postsurgery.Results:A significant effect (P < 0.017) for time existed for all clinical measures, demonstrating improvement up to 24 months in both groups. A significant interaction effect (P < 0.017) existed for pain severity and the 6-minute walk test, with accelerated group patients reporting significantly less severe pain and demonstrating superior 6-minute walk distance over the period. Although there was a significant group effect (P < 0.017) for maximal active knee extension range in favor of the accelerated regime, no further significant differences existed. There was no incidence of graft delamination up to 24 months that resulted directly from the 3-month postoperative rehabilitation program.Conclusion:The accelerated load-bearing approach that reduced the length of time spent ambulating on crutches produced comparable if not superior clinical outcomes up to 24 months postsurgery in the accelerated rehabilitation group, without compromising graft integrity. This accelerated regime is safe and effective and demonstrates a faster return to normal function postsurgery.

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Autologous chondrocyte implantation (ACI) has become an established technique for the repair of full-thickness chondral defects in the knee. Matrix-induced ACI (MACI) is the third and current generation of this surgical technique, and, while postoperative rehabilitation following MACI aims to restore normal function in each patient as quickly as possible by facilitating a healing response without overloading the repair site, current published guidelines appear conservative, varied, potentially outdated, and often based on earlier ACI surgical techniques. This article reviews the existing evidence-based literature pertaining to cell loading and postoperative rehabilitation following generations of ACI. Based on this information, in combination with the technical benefits provided by third-generation MACI in comparison to its surgical predecessors, we present a rehabilitation protocol for patients undergoing MACI in the tibiofemoral joint that has now been implemented for several years by our institution in patients with MACI, with good clinical outcomes.

Background: Early discharge programmes in hospitals are encouraged to increase financial efficiency and bed availability, but standards of clinical care must not be compromised. Criteria for safe hospital discharge must be established and objective data are needed to assess how rapidly patients can achieve these discharge criteria. Methods: A prospective study was performed on 65 patients (mean age = 71 years) scheduled for primary total hip arthroplasty (THA). The Modified Barthel Index (MBI) was measured pre-operatively and postoperatively at set intervals to assess recovery of function after THA. A score of 90 out of a possible 100 was used as a discharge criterion and indicated that the patient was functionally independent for safe hospital discharge. In addition, a combined score for thigh flexion and extension isokinetic peak strength was recorded for each patient before and after surgery. The number and nature of comorbidities and complications were also recorded. Results:The length of hospital stay in this sample varied from 5 to 39 days. The MBI scores increased rapidly between days 3 and 5, then began to plateau from day 8 onwards. Based on the MBI, 58% of patients were fit for discharge at or before day 8. The remainder were fit for discharge from day 10 onwards (mean = 14.2 days). The latter group who required an extended hospital stay were older ( P = 0.003). had more identified comorbidities ( P = 0.01) and were weaker in their hip musculature prior to surgery ( P = 0.01). compared to those who were discharged by day 8. A logistic regression analysis indicated that the pre-operative MBI score and hip strength score were strong predictors of timing for hospital discharge. Conclusions: A clinical pathway with functional milestones laid out over 8 days would be an appropriate criterion for the discharge of the majority of patients. However, approximately 40% of the patients presented in this study required a longer hospital stay before the criteria for safe discharge could be achieved. These patients can be identified pre-operatively by screening their MBI and composite hip strength scores.