The Conformity of Rehabilitation Protocols Used for Different Cartilage Repairs of the Knee Joint—A Review on Rehabilitation Standards in German Speaking Countries

Abstract

The present study analysed current rehabilitation protocols to investigate whether there is a standard for early rehabilitation after microfracturing (MFX), matrix-assisted cartilage transplantation (MACT), and osteochondral autograft transfer (OATS) of the knee joint in clinical routine, and if rehabilitation protocols differ in the repair technique used or the localization of the cartilage defect. The evaluation included rehabilitation criteria such as weight-bearing, range of motion, use of an orthosis, motion therapy, and rehabilitation training during the early rehabilitation phase after MFX, MACT, and OATS of the femorotibial and retropatellar joint space. We analysed 153 rehabilitation protocols after cartilage repair of the knee joint, including 137 protocols for after repair of the main weight-bearing (femorotibial) area and 16 for after retropatellar cartilage repair. Most of the protocols differed significantly according to the location of the repair and the procedure performed. Our findings indicate that full weight-bearing can be achieved significantly faster after MFX (5.6 weeks) and OATS (5.3 weeks) than after MACT of the main weight-bearing zone (6.6 weeks, p < 0.001). In addition, after retropatellar cartilage repair, patients are allowed full weight-bearing after 2.1 weeks compared to the main weight-bearing zone (5.3–6.6 weeks; p < 0.001). No standardized rehabilitation recommendations have been established. The present study shows that rehabilitation needs to be adjusted to the surgical technique and the location of the defect zone, and further investigation is warranted to establish standardized rehabilitation protocols after cartilage repair of the knee joint.

Standardized Rehabilitation or Individual Approach?—A Retrospective Analysis of Early Rehabilitation Protocols after Isolated Posterior Cruciate Ligament Reconstruction

“…The fact that different post-treatment protocols—based on fixed postoperative time points—partly differ significantly in their respective rehabilitative criteria is not PCL-specific but also applies to other surgical therapies such as repair of the meniscus [ 27 , 28 ], the ACL [ 23 , 29 ], the medial patellofemoral ligament [ 30 , 31 ], or cartilage [ 24 ].…”

“…Yet, standardized post-treatment protocols are often used to guide patients through the rehabilitation process and to instruct their physical therapists on weight bearing, the range of motion (ROM), and the begin of rehabilitative training. As recently shown, post-treatment protocols vary significantly, even for well-established and frequently used surgical therapies of the knee joint, such as ACL reconstruction [ 23 ] or cartilage-reparative procedures [ 24 ].…”

Within or Without You? A Perspective Comparing In Situ and Ex Situ Tissue Engineering Strategies for Articular Cartilage Repair

“…[168,167] In clinical practice rehabilitation programs can be individualized depending on the location of the lesion (e.g., patellofemoral versus tibiofemoral) as well as the patient's age and body mass index. [164,165] Despite some variation in rehabilitation protocols according to the kind of cartilage repair procedure performed, most clinicians conform in avoiding full weight bearing for a minimum of four weeks after surgery, and also in beginning motion therapy within 1 week. [164] In the longer term, the time to return to active sport can range between 6 and 18 months, with differences based on treatment strategies.…”

“…[164,165] Despite some variation in rehabilitation protocols according to the kind of cartilage repair procedure performed, most clinicians conform in avoiding full weight bearing for a minimum of four weeks after surgery, and also in beginning motion therapy within 1 week. [164] In the longer term, the time to return to active sport can range between 6 and 18 months, with differences based on treatment strategies. [168,169] Data for post-operative care following novel tissue engineering implantation is more sparse, and so optimum strategies are yet to be defined.…”

“…[170] This protocol broadly matches that recommended by most surgeons following conventional treatments. [164] Considering this conservative tendency, the protocols recommended for ex situ and in situ therapies are likely to be similar in the near term. Defining optimum post-operative care following cartilage engineering therapies will require coordinated efforts of multidisciplinary research teams including surgeons, physiotherapists, and basic scientists.…”