OSTEOCHONDRAL ALLOGRAFT TRANSPLANTATION for the KNEE: POST-OPERATIVE REHABILITATION

Haber, Daniel B.; Logan, Catherine; Murphy, Colin P.; Sanchez, Anthony; LaPrade, Robert F.; Provencher, Matthew T.

doi:10.26603/ijspt20190487

Cited by 18 publications

(18 citation statements)

References 44 publications

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“…In the case of large lesions, up to 8–9 cm 2 , multiple plugs can be used but with a risk of significant donor site morbidity (Richter et al, 2016 ; Kato et al, 2018 ). Unlike autograft, allografts use full-thickness cartilage that can be harvested from locations that correlate with the defects to be filled allowing more precise matching of the size and contour of the articular surface (Assenmacher et al, 2016 ; Haber et al, 2019 ). Even though allografts can be performed as a single staged procedure and have shown good survival rate in short to medium term (5–10 years), long term follow-up has shown considerable reoperation (30.2%) and high failure rates (18.2%) over time (Familiari et al, 2018 ).…”

Section: Current Clinical Therapiesmentioning

confidence: 99%

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Davis

Roldo

Blunn

et al. 2021

Front. Bioeng. Biotechnol.

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Articular cartilage is a highly specialised connective tissue of diarthrodial joints which provides a smooth, lubricated surface for joint articulation and plays a crucial role in the transmission of loads. In vivo cartilage is subjected to mechanical stimuli that are essential for cartilage development and the maintenance of a chondrocytic phenotype. Cartilage damage caused by traumatic injuries, ageing, or degradative diseases leads to impaired loading resistance and progressive degeneration of both the articular cartilage and the underlying subchondral bone. Since the tissue has limited self-repairing capacity due its avascular nature, restoration of its mechanical properties is still a major challenge. Tissue engineering techniques have the potential to heal osteochondral defects using a combination of stem cells, growth factors, and biomaterials that could produce a biomechanically functional tissue, representative of native hyaline cartilage. However, current clinical approaches fail to repair full-thickness defects that include the underlying subchondral bone. Moreover, when tested in vivo, current tissue-engineered grafts show limited capacity to regenerate the damaged tissue due to poor integration with host cartilage and the failure to retain structural integrity after insertion, resulting in reduced mechanical function. The aim of this review is to examine the optimal characteristics of osteochondral scaffolds. Additionally, an overview on the latest biomaterials potentially able to replicate the natural mechanical environment of articular cartilage and their role in maintaining mechanical cues to drive chondrogenesis will be detailed, as well as the overall mechanical performance of grafts engineered using different technologies.

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Section: Current Clinical Therapiesmentioning

confidence: 99%

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Davis

Roldo

Blunn

et al. 2021

Front. Bioeng. Biotechnol.

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“…Weightbearing restrictions are applied following surgery to protect the transplanted graft from both compressive and shear forces. 16 However, several animal studies caution against lengthy immobilization and excessively cautious weight bearing due to associated thinning of articular cartilage and decreased synthesis of proteoglycan. [27][28][29][30][31] From the protocols analyzed in this study, following OAT, patients achieved FWB status on average at 6.9 weeks postoperatively with the time ranging from 0 to 9 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…More recent therapy programs are found to provide combined protocols for OAT and OCA procedures or are in the presence of concomitant procedures, such as ACI, mosaicplasty, and microfracture, yet little effort has gone into isolated analysis of these procedures. 16,17 Although existing literature suggests that standardization of rehabilitation protocols could optimize therapy and decrease health care expenses, there are no standardized postoperative rehabilitation protocols for OAT or OCA. 18,19 Postoperative rehabilitation for anterior cruciate ligament reconstruction, 20 medial patellofemoral ligament reconstruction, 21 meniscal repair, 22 proximal hamstring repair, 23 Achilles tendon repair, 24 ulnar collateral ligament reconstruction, 25 and microfracture 26 have been analyzed in previous studies and were noted to have considerable variation in content and timing for the initiation of different components of rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee

et al. 2022

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Objective The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee. Design Online postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. Results A total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Conclusion A minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.

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“… 21 In addition, a recently published OCA transplant postoperative therapy protocol by Haber et al recommended immediate knee ROM after OCA, both active and passive, with emphasis on achieving full extension as soon as possible. 22 …”

Section: Discussionmentioning

confidence: 99%

Quality and Variability of Physical Therapy Protocols Varies Widely for Osteochondral Allograft Transplantation of the Femoral Condyles

et al. 2022

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Objective To assess the quality and variability of osteochondral allograft (OCA) transplantation rehabilitation protocols associated with academic orthopedic programs in the United States. Design A systematic review was performed to collect all publicly available online rehabilitation protocols for femoral condyle OCA transplant from US academic orthopedic programs participating in the Electronic Residency Application Service. These protocols were evaluated for inclusion of different rehabilitation components as well as timing of suggested initiation of these activities. Results A total of 22 protocols were included. Although 91% of protocols recommended bracing, wide variation exists in total time of utilization. Median time for full weight bearing (FWB) was 7 weeks (range 4-8). On average, each protocol mentioned 9 (range 2-18) different strengthening exercises. The median time suggested to return to high-impact activities was 9 months (range 8-12). Only 3 protocols (14%) offered criteria of advancement for each phase as well as criteria for discharge. Conclusion Very few of the academic orthopedic programs have published online rehabilitation protocols following OCA transplantation. Although there is wide variation between the protocols, it allowed the identification of trends or patterns that are more common. However, there is need for more standardized evidence-based rehabilitation protocols which are easy to understand and follow by patients.

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OSTEOCHONDRAL ALLOGRAFT TRANSPLANTATION for the KNEE: POST-OPERATIVE REHABILITATION

Cited by 18 publications

References 44 publications

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee

Quality and Variability of Physical Therapy Protocols Varies Widely for Osteochondral Allograft Transplantation of the Femoral Condyles

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