Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 2, pp 217–230 | Cite as

Rehabilitation before regenerative cartilage knee surgery: a new prehabilitation guideline based on the best available evidence

  • Anja Hirschmüller
  • Wolfgang Schoch
  • Heiner BaurEmail author
  • Barbara Wondrasch
  • Lukas Konstantinidis
  • Nobert P. Südkamp
  • Philipp Niemeyer
Arthroscopy and Sports Medicine



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.


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.


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.


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.


Knee injuries Knee osteoarthritis Articular cartilage Rehabilitation Resistance training 



The authors are grateful to the two professional translators Carole Cürten and Duncan Cummins for language support as well as to the medical students Tanja Papke and Tasja Andrees for their support in improving the program and collegiality.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopedics and Trauma SurgeryAlbert-Ludwigs University of Freiburg, Medical CenterFreiburgGermany
  2. 2.Altius Swiss Sportmed Center AGRheinfeldenSwitzerland
  3. 3.PULZ Physiotherapie und Lauftherapie ZentrumFreiburgGermany
  4. 4.Bern University of Applied Sciences, Health, PhysiotherapyBernSwitzerland
  5. 5.Center for Joints and Cartilage, Department of TraumatologyMedical University of ViennaViennaAustria
  6. 6.OCM Orthopädische Chirurgie MünchenMunichGermany

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