Rehabilitation after MACT in the Knee: Presentation of Two Rehabilitation Protocols after MACT According to Defect Localisation Based on the Biomechanics of the Knee, the Physiology of Cartilage and the Healing Process of the Graft

Abstract

AbbreviationsADLs: activities of daily life FWB: full weight-bearing NWB: non-weight-bearing PWB: partial weight-bearing TWB: touch weight-bearing It is generally accepted that rehabilitation is a critical factor in the outcome of MACT and that, in order to maximise the benefits of MACT, it is essential for the patients to adhere to an MACTspecific rehabilitation programme [1,11].The aims of the rehabilitation after MACT are to ensure an optimal graft healing by local adaptation and remodelling of the repair and to return the patient to an optimal level of function. AbstractMatrix-associated chondrocyte transplantation (MACT), an advancement of the classical autologous chondrocyte transplantation (ACT), is a tissue engineering technique for the treatment of full thickness articular defects and requires the use of a cell-scaffold construct which is implanted in the debrided cartilage defect. To achieve both good objective and subjective results and to maximise the benefits of MACT, patients have to adhere to an MACT-specific rehabilitation programme. The aims of the rehabilitation after MACT are to ensure an optimal graft healing by local adaptation and remodelling of the repair and to return the patient to an optimal level of function. It is a challenge to optimise the achievement of these two controversial goals -graft protection and return to function -within rehabilitation. The three main components of the individualised and progressive, yet safe, rehabilitation programme are: progressive weight bearing, restoration of range of motion (ROM) and enhancement of muscle control and strengthening. The modalities of the three main components, that are progressive weight bearing, restoration of ROM and enhancement of muscle control and strengthening, are based on the physiology of cartilage, the biomechanics of the knee and the biology of the graft.