Introduction

Articular cartilage injuries in the knee are observed with increasing incidence in both amateur and elite athletes. These injuries can be found either as a concomitant or as a stand-alone injury and result from acute and chronic joint stress associated with high impact sports. Recent surgical treatment options have been shown to successfully restore articular cartilage surfaces and allow athletes to return to high-impacts sports after a tailored and individualized rehabilitation program has been successfully completed. The rehabilitation program should take into consideration the biology of the cartilage repair technique, the defect characteristics and the athlete´s sport-specific demands. Further, progression within rehabilitation should be stepwise and criteria-based and rehabilitation should aim not only to achieve the pre-injury level, but also to continue sport participation, reduce the risk for reinjury and the progression to further joint degeneration. Rehabilitation after cartilage consists of three different phases:

Protection and joint activation

Joint loading and functional restoration

Activity restoration

The third phase is the transition phase for returning to sports and should therefore include sport-specific elements, reconditioning and on-field rehabilitation. This phase should allow a continued recovery and should address any remaining impairments in muscle power, sensorimotor control, metabolic impairment and sport-specific movement patterns. The principles of motor learning and in particular the advantages of the external focus of attention might help to optimize movement strategies, to regain confidence and to avoid fear avoidance mechanism. The use of modern technologies (virtual reality, movement apps, …) seems to be beneficial in terms of motivation and increasing athlete´s compliance.

The progression from one phase to the next should be criteria-based. These criteria should include subjective and objective outcomes and should ideally include all components of the International Classification of Functioning, Disability and Health (ICF). Patient education including understanding the issues of cartilage injuries and the importance of complying with the rehabilitation measures is critical to a successful return to sports. The decision of safely return athletes to sports after cartilage surgery is a critical decision and vary greatly for similar conditions and circumstances. Moreover, the question of how quickly to allow patients to return to sports and what are clinical factors and criteria that influence this decision has not been clearly answered so far.

Content

Articular cartilage injuries in the knee are observed with increasing incidence in both amateur and elite athletes. These injuries can be found either as a concomitant or as a stand-alone injury and result from acute and chronic joint stress associated with high impact sports. Recent surgical treatment options have been shown to successfully restore articular cartilage surfaces and allow athletes to return to high-impacts sports after a tailored and individualized rehabilitation program has been successfully completed. The rehabilitation program should take into consideration the biology of the cartilage repair technique, the defect characteristics and the athlete´s sport-specific demands. Further, progression within rehabilitation should be stepwise and criteria-based and rehabilitation should aim not only to achieve the pre-injury level, but also to continue sport participation, reduce the risk for reinjury and the progression to further joint degeneration. Rehabilitation after cartilage consists of three different phases:

Protection and joint activation

Joint loading and functional restoration

Activity restoration

The third phase is the transition phase for returning to sports and should therefore include sport-specific elements, reconditioning and on-field rehabilitation. This phase should allow a continued recovery and should address any remaining impairments in muscle power, sensorimotor control, metabolic impairment and sport-specific movement patterns. The principles of motor learning and in particular the advantages of the external focus of attention might help to optimize movement strategies, to regain confidence and to avoid fear avoidance mechanism. The use of modern technologies (virtual reality, movement apps, …) seems to be beneficial in terms of motivation and increasing athlete´s compliance.

The progression from one phase to the next should be criteria-based. These criteria should include subjective and objective outcomes and should ideally include all components of the International Classification of Functioning, Disability and Health (ICF). Patient education including understanding the issues of cartilage injuries and the importance of complying with the rehabilitation measures is critical to a successful return to sports. The decision of safely return athletes to sports after cartilage surgery is a critical decision and vary greatly for similar conditions and circumstances. Moreover, the question of how quickly to allow patients to return to sports and what are clinical factors and criteria that influence this decision has not been clearly answered so far.

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