Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete

Abstract

Synopsis Articular cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant acute and chronic joint stress associated with impact sports. Left untreated, articular cartilage defects can lead to chronic joint degeneration and athletic and functional disability. Treatment of articular cartilage defects in the athletic population presents a therapeutic challenge due to the high mechanical demands of athletic activity. Several articular cartilage repair techniques have been shown to successfully restore articular cartilage surfaces and allow athletes to return to high-impact sports. Postoperative rehabilitation is a critical component of the treatment process for athletic articular cartilage injury and should take into consideration the biology of the cartilage repair technique, cartilage defect characteristics, and each athlete's sport-specific demands to optimize functional outcome. Systematic, stepwise rehabilitation with criteria-based progression is recommended for an individualized rehabilitation of each athlete not only to achieve initial return to sport at the preinjury level but also to continue sports participation and reduce risk for reinjury or joint degeneration under the high mechanical demands of athletic activity. J Orthop Sports Phys Ther 2012;42(3):254–273. doi:10.2519/jospt.2012.3665

Return to running following knee osteochondral repair using an anti-gravity treadmill: A case report

“…33 The minimal perceptible clinical improvement (MPCI) of the KOOS was initially purported to be 8-10 points. 34 However, a recent study in knee cartilage repair patients has shown that the MCID varies across the KOOS subscales: Symptoms (9); Pain (14); Activities of Daily Living (ADL) (10); Sports and Recreation (Sport/Rec)(28); and Quality of Life (QoL) (28). 20 …”

“…13,28 The ability to run on a treadmill at 8km/h for more than 10 minutes is one of the criteria for progression from rehabilitation Phase 2 (Matrix production and A B C organisation) to Phase 3 (Repair cartilage maturation) following knee osteochondral repair. 28 An AlterG Anti-Gravity Treadmill P200 model was used to manipulate loading during a graduated phased return to running.…”

“…13,28 The ability to run on a treadmill at 8km/h for more than 10 minutes is one of the criteria for progression from rehabilitation Phase 2 (Matrix production and A B C organisation) to Phase 3 (Repair cartilage maturation) following knee osteochondral repair. 28 An AlterG Anti-Gravity Treadmill P200 model was used to manipulate loading during a graduated phased return to running. 7 The AlterG treadmill has been found to have minor deviations in unloading but these are less than 5% for 40-90% body weight 24 which is less than the typical deviations in accuracy in partial weight bearing with crutches after cartilage repair of the knee.…”

Exploring Cross-Curriculum Content of Undergraduate Musculoskeletal Therapy Courses Regarding Articular Cartilage; Implications of Surveying UK Healthcare Curriculum Providers

“…Generic rehabilitation protocols may fail to engender the nuances required for individuals [14,47]; the ability to recognise the necessary adaptations or specialisation may also be indicative of the complex processing developed at HE Level 7 and above [48]. Undergraduates are becoming increasingly expected to deal with uncertainty and complexity by potentially working with pedagogues as peers from early stages of HE [49].…”

Managing Knee Injuries: Keeping Up With Changes

“…20 Consequently, we are challenged to continue to adapt our clinical treatments to best complement recent advances in surgery. 13 We still have a long way to go, both surgically and with rehabilitation, before we can claim optimal long-term results with chondral injuries. But much progress has been made over the past 20 years and the future is promising.…”