Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee

Abstract

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.

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.…”

“…As well as accounting for possible deterioration of tissue that could take place after longer exposure after defrosting of the donor legs. The postoperative use of CPM is used in most post-operative rehabilitation protocols following cartilage repair procedures [ 33 , 34 ]. Based on the current experiments the applied protocol seems suitable and can be applied in clinical trial setting as well.…”

Management of Articular Cartilage Defects in the Knee: An Evidence-Based Algorithm

“…Weight-bearing is initially limited during the first 3 to 5 days but permitted as tolerated after chondroplasty 58 . OAT and OCA provide a mature cartilage surface and are generally held non–weight-bearing for 3 weeks, followed by progression to limited weight-bearing while locked in extension, and finally full–weight-bearing at 6 weeks 56,59 . Microfracture, matrix-induced ACI, and PJAC techniques do not provide a mature cartilage surface and are generally non–weight-bearing for 6 weeks with a return to full activity projected at 9 to 12 months 6 .…”