Introduction

Postoperative rehabilitation programs following articular cartilage repair procedures will vary greatly among patients and need to be individualized based on the nature of the lesion, the unique characteristics of the patient, and the type and detail of each surgical procedure. These programs are based on knowledge of the basic science, anatomy, and biomechanics of articular cartilage as well as the biological course of healing following surgery.

Several principles exist that must be considered when designing a rehabilitation program following articular cartilage repair procedures. These key principles are based on our understanding of the basic science and mechanics of articular cartilage.

Content

The rehabilitation program should be individualized to the specific demands of each patient’s activities of daily living, work, and/or sport activities.There are also several variables to consider in regard to the lesion that may have a dramatic effect on the rehabilitation process. Most importantly is the exact location of the lesion. Rehabilitation of lesions on a weight-bearing surface of a femoral condyle must attempt to avoid deleterious compressive forces and require a different approach than for lesions located within the trochlea or retrosurface of the patella, where excessive shear forces should be minimized. The size, depth, and containment of each lesion must also be considered. Lesions that are large, deep, or poorly contained within healthy surrounding articular cartilage may require a slower rehabilitation progression than smaller, shallower, or well-contained lesions.

Currently our greatest knowledge of rehabilitation of articular cartilage lesions exists in the early phase after surgical treatment. It is acknowledged that protection of the surgical site is crucial by e.g. reducing the amount of weight bearing to create an environment that facilitates the healing process while avoiding potentially deleterious forces to the repair site. However, much is less known about later phases of rehabilitation in regards to the amount, specificity, frequency, intensity and type of loading that promotes healing.

It is paramount to reduce swelling and pain as both have a direct relationship with neurophysiological alterations that occur after knee surgery. Arthrogenic muscle inhibition needs to be targeted very early to reduce the risk of irreversible changes in the central nervous system that negavitlvey impacts neural drive of particular the quadriceps muscle.

In addition aquiring normal movement patterns if of great importance. In this presentation novel motor learning principles will be presented that are underrepresented in the domain of cartilage rehabilitation.

Finally, patient education regarding their condition and how to enhance self-management and advocating an active life style to promote long term health should have high priority among clinicians.

References

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

Hirschmüller A, Schoch W, Baur H, Wondrasch B, Konstantinidis L, Südkamp NP, Niemeyer P. Arch Orthop Trauma Surg. 2019 Feb;139(2):217-230. doi: 10.1007/s00402-018-3026-6. Epub 2018 Aug 21.

2. Osteochondral Allograft Transplantation for Knee Cartilage and Osteochondral Defects: A Review of Indications, Technique, Rehabilitation, and Outcomes. Cavendish PA, Everhart JS, Peters NJ, Sommerfeldt MF, Flanigan DC. JBJS Rev. 2019 Jun;7(6):e7. doi: 10.2106/JBJS.RVW.18.00123.

3. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. Logerstedt DS, Scalzitti DA, Bennell KL, Hinman RS, Silvers-Granelli H, Ebert J, Hambly K, Carey JL, Snyder-Mackler L, Axe MJ, McDonough CM. J Orthop Sports Phys Ther. 2018 Feb;48(2):A1-A50. doi: 10.2519/jospt.2018.0301.

4. Articular Cartilage Injuries of the Knee: Patient Health Literacy, Expectations for Management, and Clinical Outcomes. Cole BJ, Redondo ML, Cotter EJ. Cartilage. 2021 Apr;12(2):139-145. doi: 10.1177/1947603518816429. Epub 2018 Nov 28.

5. Postoperative Management for Articular Cartilage Surgery in the Knee. Crecelius CR, Van Landuyt KJ, Schaal R. J Knee Surg. 2021 Jan;34(1):20-29. doi: 10.1055/s-0040-1718605.

6. Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. Pietrosimone B, Lepley AS, Kuenze C, Harkey MS, Hart JM, Blackburn JT, Norte G. J Sport Rehabil. 2022 Feb 14:1-13. doi: 10.1123/jsr.2021-0128.

7. Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. Norte G, Rush J, Sherman D. J Sport Rehabil. 2021 Dec 9:1-19. doi: 10.1123/jsr.2021-0139.

8. Linking Gait Biomechanics and Daily Steps Post ACL-Reconstruction. Lisee C, Davis-Wilson H, Evans-Pickett A, Horton WZ, Blackburn T, Franz JR, Thoma L, Spang JT, Pietrosimone B. Med Sci Sports Exerc. 2022 Jan 21. doi: 10.1249/

9. Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. Gokeler A, Neuhaus D, Benjaminse A, Grooms DR, Baumeister J. Sports Med. 2019 Jun;49(6):853-865. doi: 10.1007/