Rehabilitation Variability Following Femoral Condyle and Patellofemoral Microfracture Surgery of the Knee

Abstract

Objective: To assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for microfracture of femoral condyle and patellofemoral lesions of the knee. Design: Online postoperative microfracture 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 18 programs (11.6%) from 155 US academic orthopedic programs’ published online protocols and a total of 44 protocols were analyzed. Seventeen protocols (56.7%) recommended immediate postoperative bracing for femoral condyle lesions and 17 (89.5%) recommended immediate postoperative bracing for patellofemoral lesions. The average time to permitting weight-bearing as tolerated (WBAT) was 6.1 weeks (range, 0-8) for femoral condyle lesions and 3.7 weeks (range, 0-8 weeks) for patellofemoral lesions. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. For femoral condyle lesions, 10 protocols (33.3%) recommended functional testing prior to return to sport at an average of 23.3 weeks postoperatively (range, 12-32 weeks). For patellofemoral lesions, 4 protocols (20.0%) recommended functional testing for return to sport at an average of 21.0 weeks postoperatively (range, 12-32 weeks). Conclusion: A minority of US academic orthopedic programs publish microfracture 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.

Dextran-tryamine hydrogel maintains position and integrity under simulated loading in a human cadaver knee model

“…The used experimental set-up of non-load bearing with minimal movement after application of the injectable hydrogel is in line with the local post-operative regimen following cartilage repair procedures [ 33 , 34 ]. This rehabilitation protocol consists of an early protection phase of 6 weeks, with no weight-bearing following the surgery, to protect recovering tissues from excessive loading and shear forces.…”

Advances in Bioresorbable Triboelectric Nanogenerators

“…Stem cell therapy delivered through intravascular injection, intra-articular injection, or cell transplantation is also a promising alternative, requiring additional long-term studies to determine its efficacy and safety. 452,453 Cartilage tissue engineering, which involves the use of seed cells, engineered scaffolds, and cell growth factors, is a highly researched area ,as it provides an unlimited source of repair materials. 454,455 However, the hyaline cartilage produced by this approach may not withstand the stress of repeated joint movements as well as normal cartilage.…”

“…Both have advantages and limitations, such as the high preservation cost of allogeneic transplants, the possibility of exogenous diseases and immune solid responses caused by allogenic antigens, and the limited availability of raw materials for autologous transplants. , The field of microfracture self-healing is still in early development, and further research is required to prove its efficacy. Stem cell therapy delivered through intravascular injection, intra-articular injection, or cell transplantation is also a promising alternative, requiring additional long-term studies to determine its efficacy and safety. , Cartilage tissue engineering, which involves the use of seed cells, engineered scaffolds, and cell growth factors, is a highly researched area ,as it provides an unlimited source of repair materials. , However, the hyaline cartilage produced by this approach may not withstand the stress of repeated joint movements as well as normal cartilage. , Therefore, there is a continuous demand for efficient methods to augment chondrocyte proliferation.…”

Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee

“…To focus on evidence-based rehabilitation modalities and their initiation, this study focused on protocols associated with academic institutions as performed in previous investigations. [21][22][23][24][25][26] While many online protocols provide general guidelines, surgeons may individualize rehabilitation protocols based on patients' preoperative condition and intraoperative findings. These protocols are often given to patients and physical therapists and, therefore, are not available online.…”

“…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. The present study aims to assess the variability in OAT and OCA rehabilitation by utilizing online protocols published by academic orthopedic surgery programs in the United States.…”