Anja Hirschmüller1,2, Wolfgang Schoch1,3, Heiner Baur4, Barbara Wondrasch5, Lukas Konstantinidis1, Nobert P Südkamp1, Philipp Niemeyer1,6. 1. Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University of Freiburg, Medical Center, Freiburg, Germany. 2. Altius Swiss Sportmed Center AG, Rheinfelden, Switzerland. 3. PULZ Physiotherapie und Lauftherapie Zentrum, Freiburg, Germany. 4. Bern University of Applied Sciences, Health, Physiotherapy, Bern, Switzerland. heiner.baur@bfh.ch. 5. Center for Joints and Cartilage, Department of Traumatology, Medical University of Vienna, Vienna, Austria. 6. OCM Orthopädische Chirurgie München, Munich, Germany.
Abstract
INTRODUCTION: Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field. The preoperative time frame may be used to start rehabilitation which may fasten the postoperative recovery and optimize clinical outcome ("Prehabilitation"-PREHAB). The aim of this article, therefore, was to review the available literature on prehabilitation concepts and to present a prehabilitation guideline for CRS patients based on the best evidence available. METHODS: A systemic literature research was conducted on rehabilitation for cartilage regenerative surgery as well as prehabilitation in knee joint procedures. From the available literature a prehabilitation concept was generated and tested in 10 ACI patients. RESULTS: As the literature search found no studies addressing prehabilitation in CRS patients, an evidence-based PREHAB program has been compiled based on the available evidence from (a) studies addressing postoperative rehabilitation in CRS patients and (b) PREHAB studies on other knee procedures including TKA. This presented prehabilitation guideline has been tested in > 50 CRS patients and was found to be feasible as all of the patients showed a good compliance and were able to perform the protocol as suggested. CONCLUSION: The presented PREHAB regimen may serve clinicians as a guideline for early rehabilitation of their CRS patients. Obviously, further research is mandatory to quantify its clinical effect and to demonstrate its cost-effectiveness and benefits in surgically treated patients.
INTRODUCTION: Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field. The preoperative time frame may be used to start rehabilitation which may fasten the postoperative recovery and optimize clinical outcome ("Prehabilitation"-PREHAB). The aim of this article, therefore, was to review the available literature on prehabilitation concepts and to present a prehabilitation guideline for CRSpatients based on the best evidence available. METHODS: A systemic literature research was conducted on rehabilitation for cartilage regenerative surgery as well as prehabilitation in knee joint procedures. From the available literature a prehabilitation concept was generated and tested in 10 ACI patients. RESULTS: As the literature search found no studies addressing prehabilitation in CRSpatients, an evidence-based PREHAB program has been compiled based on the available evidence from (a) studies addressing postoperative rehabilitation in CRSpatients and (b) PREHAB studies on other knee procedures including TKA. This presented prehabilitation guideline has been tested in > 50 CRSpatients and was found to be feasible as all of the patients showed a good compliance and were able to perform the protocol as suggested. CONCLUSION: The presented PREHAB regimen may serve clinicians as a guideline for early rehabilitation of their CRSpatients. Obviously, further research is mandatory to quantify its clinical effect and to demonstrate its cost-effectiveness and benefits in surgically treated patients.
Entities:
Keywords:
Articular cartilage; Knee injuries; Knee osteoarthritis; Rehabilitation; Resistance training
Authors: Stephen G Crowley; Hasani W Swindell; Bryan M Saltzman; Christopher S Ahmad; Charles A Popkin; David P Trofa Journal: Cartilage Date: 2021-06-19 Impact factor: 3.117