Practice in rehabilitation after cartilage therapy: an expert survey

Arch Orthop Trauma Surg. 2013 Mar;133(3):311-20. doi: 10.1007/s00402-012-1662-9. Epub 2012 Dec 23.

Abstract

Background: Current cartilage therapy modalities like microfracture, ACT/MACT, AMIC or osteochondral transplantation are important tools to treat symptomatic (osteo)chondral lesions of the knee joint. However, until now there exists no high-level evidence based accepted rehabilitation plan for the postoperative treatment.

Hypothesis/purpose: This survey describes the predominantly used rehabilitation plan as implemented by expert musculoskeletal surgeons for operatively treated (osteo)chondral lesions.

Study design: Survey and systematic review.

Methods: An electronic questionnaire covering general and specific items concerning aftercare following cartilage therapy in the knee joint was designed and disposed to analyze rehabilitation programs among a population of expert musculoskeletal surgeons of the AGA (Society of arthroscopy and joint surgery). All instructors (304 in 01/2011) were included into the survey. A total of 246 (80.9 %) instructors answered the questionnaire.

Results: The predominant used therapy to treat cartilage lesions is microfracture and for osteochondral lesions the osteochondral transplantation. Physiotherapy starts directly after surgery and takes more than 6 weeks. Most surgeons do not immobilize patients after surgery and use partial weight-bearing for up to 5 weeks. The change from partial to full weight-bearing is done step-wise with a 20-kg/week increase. Free ROM is allowed by the majority of instructors (55 %) directly after surgery. A CPM-device is also used directly and up to 5 weeks. Swimming and biking are allowed after 6 weeks, running is allowed after 12 weeks and contact sports after 24 weeks. Most instructors do not use braces in the aftercare procedure, but nearly all (93 %) prescribe crutches. Typical drugs used during the aftercare are NSAID, Heparin and antibiotics. For most instructors (79 % respectively 75 %) knee stability and a straight leg axis are necessary for a successful cartilage therapy. If a concomitant therapy like ACL reconstruction or an osteotomy is performed, aftercare is mainly dependent on cartilage therapy (62 % respectively 59 % of instructors).

Conclusions: Today there exists no detailed rehabilitation program for treatment after a cartilage-related operation on the basis of an evidence-based level I study. The reason might be that many variables contribute to a specific aftercare procedure. Therefore, the survey of experienced surgeons may help to identify the most promising rehabilitation regime for today, at least until evidence-based level I studies are accomplished.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anticoagulants / therapeutic use
  • Arthroplasty, Subchondral
  • Bone Transplantation
  • Cartilage / transplantation
  • Cartilage Diseases / rehabilitation*
  • Cartilage Diseases / therapy
  • Health Care Surveys
  • Heparin / therapeutic use
  • Humans
  • Knee Joint / surgery*
  • Reconstructive Surgical Procedures
  • Surveys and Questionnaires

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Heparin