Abstract
The primary aim of any rehabilitative procedure after cartilage repair is to reach the optimal recovery of daily activities and sportive level. It is commonly accepted that most surgical procedures for cartilage repair demand a prolonged rehabilitation period of up to 6 or more months [25, 37]. To support the healing process and optimize the postoperative result, this period should be seen equally important as the operative procedure itself [54, 63]. Although high level of evidence data is limited, basic principles are commonly accepted to direct the postoperative rehabilitation [25, 33]. These should be oriented on each individual patient and his/her specific injury/lesion, the specifics of the surgical procedure, and the particularities of each individual rehab process. This allows for choosing the correct exercises and training methods. Overall, such a process requires an interdisciplinary team of all involved therapists (surgeon, physiotherapist, primary care physicians, etc.).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Alfredson H, Lorentzon R (1999) Superior results with continuous passive motion compared to active motion after periosteal transplantation. A retrospective study of human patella cartilage defect treatment. Knee Surg Sports Traumatol Arthrosc 7(4):232–238
Attfield SF, Wilton TJ, Pratt DJ, Sambatakakis A (1996) Soft-tissue balance and recovery of proprioception after total knee replacement. J Bone Joint Surg Br 78(4):540–545
Baker V, Bennell K, Stillman B, Cowan S, Crossley K (2002) Abnormal knee joint position sense in individuals with patellofemoral pain syndrome. J Orthop Res 20(2):208–214
Beard DJ, Dodd CA, Trundle HR, Simpson AH (1994) Proprioception enhancement for anterior cruciate ligament deficiency. A prospective randomised trial of two physiotherapy regimes. J Bone Joint Surg Br 76(4):654–659
Behrens F, Kraft EL, Oegema TR Jr (1989) Biochemical changes in articular cartilage after joint immobilization by casting or external fixation. J Orthop Res 7(3):335–343
Bennell KL, Hinman RS, Metcalf BR, Crossley KM, Buchbinder R, Smith M, McColl G (2003) Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis. J Orthop Res 21(5):792–797
Bowen TR, Feldmann DD, Miller MD (2004) Return to play following surgical treatment of meniscal and chondral injuries to the knee. Clin Sports Med 23(3):381–393, viii–ix
Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331(14):889–895
Brittberg M, Nilsson A, Lindahl A, Ohlsson C, Peterson L (1996) Rabbit articular cartilage defects treated with autologous cultured chondrocytes. Clin Orthop Relat Res 326:270–283
Buckwalter JA (1995) Activity vs. rest in the treatment of bone, soft tissue and joint injuries. Iowa Orthop J 15:29–42
Buckwalter JA (1998) Articular cartilage: injuries and potential for healing. J Orthop Sports Phys Ther 28(4):192–202
Buckwalter JA, Lohmander S (1994) Operative treatment of osteoarthrosis. Current practice and future development. J Bone Joint Surg Am 76(9):1405–1418
Cohen NP, Foster RJ, Mow VC (1998) Composition and dynamics of articular cartilage: structure, function, and maintaining healthy state. J Orthop Sports Phys Ther 28(4):203–215
Ebert JR, Ackland TR, Lloyd DG, Wood DJ (2008) Accuracy of partial weight bearing after autologous chondrocyte implantation. Arch Phys Med Rehabil 89(8):1528–1534
Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H (2000) Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br 82(6):801–806
Friden T, Roberts D, Ageberg E, Walden M, Zatterstrom R (2001) Review of knee proprioception and the relation to extremity function after an anterior cruciate ligament rupture. J Orthop Sports Phys Ther 31(10):567–576
Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR, Goodnight JL, McIlwraith CW (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227
Fuchs S, Thorwesten L, Niewerth S (1999) Proprioceptive function in knees with and without total knee arthroplasty. Am J Phys Med Rehabil 78(1):39–45
Grande DA, Pitman MI, Peterson L, Menche D, Klein M (1989) The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation. J Orthop Res 7(2):208–218
Gray ML, Pizzanelli AM, Grodzinsky AJ, Lee RC (1988) Mechanical and physiochemical determinants of the chondrocyte biosynthetic response. J Orthop Res 6(6):777–792
Grelsamer RP, Klein JR (1998) The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther 28(5):286–298
Grodzinsky AJ, Roth V, Myers E, Grossman WD, Mow VC (1981) The significance of electromechanical and osmotic forces in the nonequilibrium swelling behavior of articular cartilage in tension. J Biomech Eng 103(4):221–231
Haapala J, Arokoski J, Pirttimaki J, Lyyra T, Jurvelin J, Tammi M, Helminen HJ, Kiviranta I (2000) Incomplete restoration of immobilization induced softening of young beagle knee articular cartilage after 50-week remobilization. Int J Sports Med 21(1):76–81
Halmovici N (1982) Three years experience in direct intraarticular temperature measurement. Biomed Therm 2:453–473
Hambly K, Bobic V, Wondrasch B, Van Assche D, Marlovits S (2006) Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. Am J Sports Med 34(6):1020–1038
Hess T, Gleitz M, Hopf T, Olfs S, Mielke U (1995) Changes in muscular activity after knee arthrotomy and arthroscopy. Int Orthop 19(2):94–97
Hinterwimmer S, Krammer M, Krotz M, Glaser C, Baumgart R, Reiser M, Eckstein F (2004) Cartilage atrophy in the knees of patients after seven weeks of partial load bearing. Arthritis Rheum 50(8):2516–2520
Hirschmuller A, Baur H, Braun S, Kreuz PC, Sudkamp NP, Niemeyer P (2011) Rehabilitation after autologous chondrocyte implantation for isolated cartilage defects of the knee. Am J Sports Med 39(12):2686–2696
Hopkins J, Ingersoll CD, Edwards J, Klootwyk TE (2002) Cryotherapy and transcutaneous electric neuromuscular stimulation decrease arthrogenic muscle inhibition of the vastus medialis after knee joint effusion. J Athl Train 37(1):25–31
Horvath SM, Hollander JL (1949) Intra-articular temperature as a measure of joint reaction. J Clin Invest 28(3):469–473
Imhoff AB, Beitzel K, Stamer K, Klein E (2010) Rehabilitation in Der Orthopadischen Chirurgie: Op-Verfahren Im Uberblick – Physiotherapie – Sporttherapie. Springer, Berlin/Heidelberg/New York
Irrgang JJ, Pezzullo D (1998) Rehabilitation following surgical procedures to address articular cartilage lesions in the knee. J Orthop Sports Phys Ther 28(4):232–240
Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87(10):2232–2239
Jones DG, Peterson L (2006) Autologous chondrocyte implantation. J Bone Joint Surg Am 88(11):2502–2520
Kern H (1980) Zur Anwendung der Kryotherapie in der Praxis. Physiotherapie 71:823–825
Kern H, Fessl L, Trnavsky G, Hertz H (1984) Das Verhalten der Gelenkstemperatur unter Eisapplikation-Grundlage fur die praktische Anwendung. Wien Klin Wochenschr 96:832–837
Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Krause S, Ossendorf C, Meier D, Ghanem N, Uhl M (2007) Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year follow-up. Am J Sports Med 35(8):1261–1268
Kuenze C, Hart JM (2010) Cryotherapy to treat persistent muscle weakness after joint injury. Phys Sportsmed 38(3):38–44
Lee RC, Frank EH, Grodzinsky AJ, Roylance DK (1981) Oscillatory compressional behavior of articular cartilage and its associated electromechanical properties. J Biomech Eng 103(4):280–292
Lieber RL, Silva PD, Daniel DM (1996) Equal effectiveness of electrical and volitional strength training for quadriceps femoris muscles after anterior cruciate ligament surgery. J Orthop Res 14(1):131–138
Lorentzon R, Alfredson H, Hildingsson C (1998) Treatment of deep cartilage defects of the patella with periosteal transplantation. Knee Surg Sports Traumatol Arthrosc 6(4):202–208
McGinty G, Irrgang JJ, Pezzullo D (2000) Biomechanical considerations for rehabilitation of the knee. Clin Biomech (Bristol, Avon) 15(3):160–166
Minas T, Peterson L (1999) Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 18(1):13–44, v–vi
Nam EK, Makhsous M, Koh J, Bowen M, Nuber G, Zhang LQ (2004) Biomechanical and histological evaluation of osteochondral transplantation in a rabbit model. Am J Sports Med 32(2):308–316
O’Driscoll SW, Keeley FW, Salter RB (1986) The chondrogenic potential of free autogenous periosteal grafts for biological resurfacing of major full-thickness defects in joint surfaces under the influence of continuous passive motion. An experimental investigation in the rabbit. J Bone Joint Surg Am 68(7):1017–1035
Osbahr DC, Cawley PW, Speer KP (2002) The effect of continuous cryotherapy on glenohumeral joint and subacromial space temperatures in the postoperative shoulder. Arthroscopy 18(7):748–754
Paternostro-Sluga T, Fialka C, Alacamliogliu Y, Saradeth T, Fialka-Moser V (1999) Neuromuscular electrical stimulation after anterior cruciate ligament surgery. Clin Orthop Relat Res 368:166–175
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30(1):2–12
Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234
Pietrosimone BG, Hart JM, Saliba SA, Hertel J, Ingersoll CD (2009) Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation. Med Sci Sports Exerc 41(6):1175–1181
Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG (2003) Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther 33(11):677–685
Reider B, Arcand MA, Diehl LH, Mroczek K, Abulencia A, Stroud CC, Palm M, Gilbertson J, Staszak P (2003) Proprioception of the knee before and after anterior cruciate ligament reconstruction. Arthroscopy 19(1):2–12
Rice D, McNair PJ, Dalbeth N (2009) Effects of cryotherapy on arthrogenic muscle inhibition using an experimental model of knee swelling. Arthritis Rheum 61(1):78–83
Robert H (2002) Techniques for repair of chondral and osteochondral lesions in the knee. Principles of rehabilitation. Ann Readapt Med Phys 45(2):62–68
Roberts D, Friden T, Stomberg A, Lindstrand A, Moritz U (2000) Bilateral proprioceptive defects in patients with a unilateral anterior cruciate ligament reconstruction: a comparison between patients and healthy individuals. J Orthop Res 18(4):565–571
Rodrigo JJ, Steadman JR, Silliman JF (1994) Improvement in full- thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg 7:109–116
Salter RB (1989) The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res 242:12–25
Salter RB (1994) The physiologic basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin 10(2):211–219
Salter RB (1996) History of rest and motion and the scientific basis for early continuous passive motion. Hand Clin 12(1):1–11
Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND (1980) The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 62(8):1232–1251
Sharma L, Pai YC, Holtkamp K, Rymer WZ (1997) Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis? Arthritis Rheum 40(8):1518–1525
Shimizu T, Videman T, Shimazaki K, Mooney V (1987) Experimental study on the repair of full thickness articular cartilage defects: effects of varying periods of continuous passive motion, cage activity, and immobilization. J Orthop Res 5(2):187–197
Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391(Suppl):S362–S369
Stiene HA, Brosky T, Reinking MF, Nyland J, Mason MB (1996) A comparison of closed kinetic chain and isokinetic joint isolation exercise in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther 24(3):136–141
Van Assche D, Staes F, Van Caspel D, Vanlauwe J, Bellemans J, Saris DB, Luyten FP (2010) Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 18(4):486–495
Van Assche D, Van Caspel D, Vanlauwe J, Bellemans J, Saris DB, Luyten FP, Staes F (2009) Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up. Am J Sports Med 37(Suppl 1):42S–49S
Vanwanseele B, Lucchinetti E, Stussi E (2002) The effects of immobilization on the characteristics of articular cartilage: current concepts and future directions. Osteoarthritis Cartilage 10(5):408–419
Waldman SD, Spiteri CG, Grynpas MD, Pilliar RM, Hong J, Kandel RA (2003) Effect of biomechanical conditioning on cartilaginous tissue formation in vitro. J Bone Joint Surg Am 85-A(Suppl 2):101–105
Walker JM (1998) Pathomechanics and classification of cartilage lesions, facilitation of repair. J Orthop Sports Phys Ther 28(4):216–231
Williams JM, Moran M, Thonar EJ, Salter RB (1994) Continuous passive motion stimulates repair of rabbit knee articular cartilage after matrix proteoglycan loss. Clin Orthop Relat Res 304:252–262
Wondrasch B, Zak L, Welsch GH, Marlovits S (2009) Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle on radiographic and clinical outcome after 2 years: a prospective, randomized controlled pilot study. Am J Sports Med 37(Suppl 1):88S–96S
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 ESSKA
About this chapter
Cite this chapter
Beitzel, K., Kohn, L., Imhoff, A.B. (2014). Rehabilitation After Cartilage Repair Surgery: Part II Practical Issues. In: Shetty, A.A., Kim, SJ., Nakamura, N., Brittberg, M. (eds) Techniques in Cartilage Repair Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-41921-8_27
Download citation
DOI: https://doi.org/10.1007/978-3-642-41921-8_27
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-41920-1
Online ISBN: 978-3-642-41921-8
eBook Packages: MedicineMedicine (R0)