Skip to main content
SpringerLink
Log in

Rehabilitation of Chondral Lesions of the Knee

  • Chapter
  • First Online:
Articular Cartilage Defects of the Knee

  • 1406 Accesses

Abstract

In this chapter we review the basic principles, mechanisms of action and therapeutic indications of a number of Rehabilitation and Physical Medicine techniques commonly used for the management of patients with chondral lesions of the knee. The indications for a particular technique will depend on patient´s characteristics, type of chondral lesion and type of treatment (non-operative or surgical). Finally, we also analyse the Rehabilitation and Physical Medicine techniques used after the surgical treatment of chondral injuries of the knee (drilling, debridement, mosaicplasty, autologous chondrocyte implantation), including non-weightbearing, movilisation modalities, muscle strengthening and stretching, proprioceptive re-training, mechanotherapy and electrotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Slynarski K, Deszczynski J (2006) Algorithms for articular cartilage repair. Transplant Proc 38:316–317

    Article  PubMed  CAS  Google Scholar 

  2. Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391:S362–S369

    Article  PubMed  Google Scholar 

  3. Brittberg M (1999) Autologous chondrocyte transplantation. Clin Orthop Relat Res 367:S147–S155

    Article  PubMed  Google Scholar 

  4. Hangody L, Feczkó P, Bartha L et al (2001) Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop Relat Res 391:S328–S336

    Article  PubMed  Google Scholar 

  5. Reinold MM, Wilk KE, Macrina LC et al (2006) Current concepts in the rehabilitation following articular cartilage repair procedures in the knee. J Orthop Sports Phys Ther 36:774–794

    PubMed  Google Scholar 

  6. Plaja J (2003) Generalidades sobre electroterapia. Iontoforesis. In: Plaja J (ed) Analgesia por medios físicos. McGraw-Hill, Madrid, pp 191–204

    Google Scholar 

  7. Paillard T (2008) Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports Med 38:161–177

    Article  PubMed  Google Scholar 

  8. Vavken P, Arrich F, Schufried O, Dorotka R (2009) Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials. J Rehabil Med 41:406–411

    Article  PubMed  Google Scholar 

  9. Rao R, Nanda S (2009) Sonophoresis: recent advancements and future trends. J Pharm Pharmacol 61:689–705

    Article  PubMed  CAS  Google Scholar 

  10. Broosseau L, Welch V, Wells G et al (2007) Low level laser therapy (classes III) for treating osteoartrhitis. Cochrane Database Syst Rev 18:CD002046

    Google Scholar 

  11. McGinty G, Irrgang JJ, Pezzullo D (2000) Biomechanical considerations for rehabilitation of the knee. Clin Biomech 15:160–166

    Article  CAS  Google Scholar 

  12. Greene KA, Schurman JR (2008) Quadriceps muscle function in primary total knee arthroplasty. J Arthroplast 23:15–19

    Article  Google Scholar 

  13. Grodski M, Marks R (2008) Exercises following anterior cruciate ligament reconstructive surgery: biomechanical considerations and efficacy of current approaches. Res Sports Med 16:75–96

    Article  PubMed  Google Scholar 

  14. Wright RW, Preston E, Fleming BC et al (2008) A systematic review of anterior cruciate ligament reconstruction rehabilitation: part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. J Knee Surg 21:217–224

    Article  PubMed  Google Scholar 

  15. Fleming BC, Oksendahl H, Beynnon BD (2005) Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction? Exerc Sport Sci Rev 33:134–140

    Article  PubMed  Google Scholar 

  16. Ross MD, Denegar CR, Winzenried JA (2001) Implementation of open and closed kinetic chain quadriceps strengthening exercises after anterior cruciate ligament reconstruction. J Strength Cond Res 15:466–473

    PubMed  CAS  Google Scholar 

  17. Fitzgerald GK, Lephart SM, Hwang JH, Wainner RS (2001) Hop tests as predictors of dynamic knee stability. J Orthop Sports Phys Ther 31:588–597

    PubMed  CAS  Google Scholar 

  18. Hislop HJ, Perrine JJ (1967) The isokinetic concept of exercise. Phys Ther 47:114–117

    PubMed  CAS  Google Scholar 

  19. Dauty M, Tortellier L, Rochcongar P (2005) Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature. Int J Sports Med 26:599–606

    Article  PubMed  CAS  Google Scholar 

  20. Gaines JM, Talbot LA (1999) Isokinetic strength testing in research and practice. Biol Res Nurs 1:57–64

    Article  PubMed  CAS  Google Scholar 

  21. Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE (2006) Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 36:385–402

    PubMed  Google Scholar 

  22. López Vázquez MA (2008) Ejercicio físico terapéutico. In: Juana García FJ (ed) Primer Curso Intensivo de Revisión en Medicina Física y Rehabilitación. GRUPO76 Editorial, pp 68–78

    Google Scholar 

  23. Cooper RL, Taylor NF, Feller JA (2005) A systematic review of the effect of proprioceptive and balance exercises on people with an injured or reconstructed anterior cruciate ligament. Res Sports Med 13:163–178

    Article  PubMed  CAS  Google Scholar 

  24. Hewett TE, Paterno MV, Myer GD (2002) Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop Relat Res 402:76–94

    Article  PubMed  Google Scholar 

  25. Solomonow M, Krogsgaard M (2001) Sensorimotor control of knee stability. A review. Scand J Med Sci Sports 11:64–80

    Google Scholar 

  26. D`Amato M, Bach BR (2005) Lesiones de rodilla. In: Brotzman SB, Wilk KE (eds) Rehabilitación ortopédica clínica. Mosby, Madrid, pp 239–356

    Google Scholar 

  27. Nho SJ, Pensak MJ, Seigerman DA, Cole BJ (2010) Rehabilitation after autologous chondrocyte implantation in athletes. Clin Sports Med 29:267–282

    Article  PubMed  Google Scholar 

  28. Ahmed AM, Burke DL (1983) In vitro measurement of static pressure distribution in synovial joints—part I: tibial surface of the knee. J Biomech Eng 105:216–225

    Article  PubMed  CAS  Google Scholar 

  29. Ahmed AM, Burke DL, Yu A (1983) In vitro measurement of static pressure distribution in synovial joints—part II: retropatellar surface. J Biomech Eng 105:226–236

    Article  PubMed  CAS  Google Scholar 

  30. Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 82:1189–1195

    Article  PubMed  CAS  Google Scholar 

  31. Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ (1991) Articular contact in a threedimensional model of the knee. J Biomech 24:1019–1031

    Article  PubMed  CAS  Google Scholar 

  32. 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 34:1020–1038

    Article  PubMed  Google Scholar 

  33. Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR (2009) Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 37(Suppl):167S–176S

    Google Scholar 

  34. Salter RB, Hamilton HW, Wedge JH et al (1984) Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. J Orthop Res 1:325–342

    Article  PubMed  CAS  Google Scholar 

  35. Ho SS, Illgen RL, Meyer RW, Torok PJ, Cooper MD, Reider B (1995) Comparison of various icing times in decreasing bone metabolism and blood flow in the knee. Am J Sports Med 23:74–76

    Article  PubMed  CAS  Google Scholar 

  36. Lindenfeld TN, Hewett TE, Andriacchi TP (1997) Joint loading with valgus bracing in patients with varus gonarthrosis. Clin Orthop Relat Res 397:290–297

    Google Scholar 

  37. Beynnon BD, Johnson RJ, Fleming BC (2002) The science of anterior cruciate ligament rehabilitation. Clin Orthop Relat Res 402:9–20

    Article  PubMed  Google Scholar 

  38. Fuchs S, Thorwesten L, Niewerth S (1999) Proprioceptive function in knees with and without total knee arthroplasty. Am J Phys Med Rehabil 78:39–45

    Article  PubMed  CAS  Google Scholar 

  39. Leetun DT, Ireland ML, Willson JD et al (2004) Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc 36:926–934

    Article  PubMed  Google Scholar 

  40. Richardson CA, Jull GA (1995) Muscle control-pain control: what exercises would you prescribe? Man Ther 1:2–10

    Article  PubMed  CAS  Google Scholar 

  41. Wright RW, Preston E, Fleming BC et al (2008) A systematic review of anterior cruciate ligament reconstruction rehabilitation: part II: open versus closed kinetic chain exercises, neuromuscular electrical stimulation, accelerated rehabilitation, and miscellaneous topics. J Knee Surg. 21:225–234

    Article  PubMed  Google Scholar 

  42. Kim E, Kim T, Kang H, Lee J, Childers MK (2010) Aquatic versus land-based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study. PM&R 2:703–712

    Article  Google Scholar 

  43. Biscarini A, Cerulli G (2007) Modeling of the knee joint load in rehabilitative knee extension exercises under water. J Biomech 40:345–355

    Article  PubMed  CAS  Google Scholar 

  44. Hurst JM, Steadman JR (2010) O`Brien, et al. Rehabilitation following microfracture for chondral injury in the knee. Clin Sports Med 29:257–265

    Article  PubMed  Google Scholar 

  45. 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 31:567–576

    PubMed  CAS  Google Scholar 

  46. Kreuz PC, Steinwachs M, Erggelet C et al (2007) Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year follow-up. Am J Sports Med 35:1261–1268

    Article  PubMed  Google Scholar 

  47. Hambly K, Silvers HJ, Steinwachs M (2012) Rehabilitation after articular cartilage repair of the knee in the football (soccer) player. Cartilage 3(Suppl):50S–56S

    Article  Google Scholar 

  48. Frisbie DD, Oxford JT, Southwood L et al (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227

    Google Scholar 

  49. Marder RA, Hopkins G Jr, Timmerman LA (2005) Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy 21:152–158

    Article  PubMed  Google Scholar 

  50. Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504

    PubMed  CAS  Google Scholar 

  51. Buckwalter JA, Mankin HJ (1998) Articular cartilage repair and transplantation. Arthritis Rheum 41:1331–1342

    Article  PubMed  CAS  Google Scholar 

  52. Steadman JR, Briggs KK, Rodrigo JJ et al (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484

    Article  PubMed  Google Scholar 

  53. Steadman JR, Miller BS, Karas SG et al (2003) The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg 16:83–86

    PubMed  Google Scholar 

  54. Bartha L, Vajda A, Duska Z et al (2006) Autologous osteochondral mosaicplasty grafting. J Orthop Sports Phys Ther 36:739–750

    PubMed  Google Scholar 

  55. Whiteside RA, Bryant JT, Jakob RP, Mainil-Varlet P, Wyss UP (2003) Short-term load bearing capacity of osteochondral autografts implanted by the mosaicplasty technique: an in vitro porcine model. J Biomech 36:1203–1208

    Article  PubMed  CAS  Google Scholar 

  56. Hangody L, Kish G, Karpati Z (1997) Autogenous osteochondral graft technique for replacing knee cartilage defects in dogs. Orthop Int 5:175–181

    Google Scholar 

  57. 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 32:308–316

    Article  PubMed  Google Scholar 

  58. Fabbricciani C, Schiavone PA, Delcogliano A et al (1994) Osteochondral autograft in the treatment of osteochondritis dissecans of the knee. In: 17th AOSSM annual meeting. American orthopedic society for sports medicine, Orland, FL

    Google Scholar 

  59. Mahomed MN, Beaver RJ, Gross AE (1992) The long-term success of fresh, small fragment osteochondral allografts used for intraarticular post-traumatic defects in the knee joint. Orthopedics 15:1191–1199

    PubMed  CAS  Google Scholar 

  60. Outerbridge HK, Outerbridge AR, Outerbridge RE (1995) The use of a lateral patellar autologous graft for the repair of a large osteochondral defect in the knee. J Bone Joint Surg Am 77:65–72

    PubMed  CAS  Google Scholar 

  61. Yamashita F, Sakakida K, Suzu F, Takai S (1985) The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee. Clin Orthop Relat Res 201:43–50

    Google Scholar 

  62. Hangody L, Dobos J, Baló E et al (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38:1125–1133

    Google Scholar 

  63. Jones D, Peterson L (2006) Autologous chondrocyte implantation. J Bone Joint Surg Am 88:2502–2520

    Article  PubMed  Google Scholar 

  64. Robertson WB, Gilbey H, Ackland T (2004) Standard practice exercise rehabilitation protocols for matrix induced autologous chondrocyte implantation femoral condyles. Hollywood Functional Rehabilitation Clinic, Perth (Western Australia)

    Google Scholar 

  65. Pascual-Garrido C, Slabaugh MA, L’Heureux DR, et al (2009) Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation. Prospective evaluation at average 4-year follow-up. Am J Sports Med 37(Suppl 1):33S–41S

    Google Scholar 

  66. McNickle AG, L’Heureux DR, Yanke AB et al (2009) Outcomes of autologous chondrocyte implantation in a diverse patient population. Am J Sports Med 37:1344–1350

    Article  PubMed  Google Scholar 

  67. Zaslav K, Cole BJ, Brewster R et al (2008) A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defects of the knee. Am J Sports Med 36:1–14

    Google Scholar 

  68. Mithofer K, Peterson L, Mandelbaum BR et al (2005) Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. Am J Sports Med 33:1639–1646

    Article  PubMed  Google Scholar 

  69. Della Villa S, Kon E, Filardo G et al (2010) Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med 38:68–77

    Google Scholar 

  70. Ebert JR, Robertson WB, Lloyd DG, Zheng MH, Wood DJ, Ackland T (2008) Traditional vs accelerated approaches to post-operative rehabilitation following matrix-induced autologous chondrocyte implantation (MACI): comparison of clinical, biomechanical and radiographic outcomes. Osteoarthr Cartil 16:1131–1140

    Article  PubMed  CAS  Google Scholar 

  71. 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

    Article  PubMed  Google Scholar 

  72. Allen M, Wellen M, Hart DP, Glasoe WM (2007) Rehabilitation following autologous chondrocyte implantation surgery: case report using an accelerated weight-bearing protocol. Physiother Can 59:286–298

    Article  Google Scholar 

  73. Epaminontidis K, Papacostas E, Koutloumpasis A, Ziogas G, Terzidis J (2011) Accelerated rehabilitation following bilateral consecutive matrix autologous chondrocyte implantation in the knees of an elite skier. Br J Sports Med 45:e1. doi:10.1136/bjsm.2010.081554.68

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, “La Paz” University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain

    Hortensia De la Corte-Rodríguez

  2. Department of Physical Medicine and Rehabilitation, “Doce de octubre” University Hospital, Avenida de Córdoba s/n, 28041, Madrid, Spain

    Juan M. Román-Belmonte

  3. Department of Physical Medicine and Rehabilitation, “12 de Octubre” University Hospital, Avenida de Córdoba s/n, 28041, Madrid, Spain

    Hortensia De la Corte-García

Authors
  1. Hortensia De la Corte-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan M. Román-Belmonte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hortensia De la Corte-García
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Hortensia De la Corte-Rodríguez or Juan M. Román-Belmonte .

Editor information

Editors and Affiliations

  1. Capitan Blanco Argibay 21-G-3A, Madrid, 28029, Spain

    E. Carlos Rodrìguez-Merchán

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

De la Corte-Rodríguez, H., Román-Belmonte, J.M., De la Corte-García, H. (2012). Rehabilitation of Chondral Lesions of the Knee. In: Rodrìguez-Merchán, E. (eds) Articular Cartilage Defects of the Knee. Springer, Milano. https://doi.org/10.1007/978-88-470-2727-5_10

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2727-5_10

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2726-8

  • Online ISBN: 978-88-470-2727-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation