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

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

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.

Funding

There is no funding source.

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Corresponding author

Correspondence to Heiner Baur.

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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.

Appendix: Prehabilitation program

Appendix: Prehabilitation program

Warm up

Fig. 1
figure1

Stationary bike

See Figs. 1 and 2.

Fig. 2
figure2

Treadmill

Sensorimotor exercises

See Figs. 3, 4, 5, 6, 7, 8, 9, 10 and 11.

Fig. 3
figure3

Bench alternate legs

Fig. 4
figure4

Sideway bench static

Fig. 5
figure5

Single-leg toe touch

Fig. 6
figure6

Single-leg toe touch adding an Airex® pad

Fig. 7
figure7

Squats

Fig. 8
figure8

Squats with toe raise

Fig. 9
figure9

Lunges

Fig. 10
figure10

Vertical jumps

Fig. 11
figure11

Side to side-bounds

Strength training

See Figs. 12, 13, 14, 15 and 16

Fig. 12
figure12

One-leg leg press (45° position)

Fig. 13
figure13

One-leg leg curl: leg extension

Fig. 14
figure14

One-leg leg curl: leg flexion

Fig. 15
figure15

Nordic hamstrings

Fig. 16
figure16

Hip abduction with pulley resistance

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Hirschmüller, A., Schoch, W., Baur, H. et al. Rehabilitation before regenerative cartilage knee surgery: a new prehabilitation guideline based on the best available evidence. Arch Orthop Trauma Surg 139, 217–230 (2019). https://doi.org/10.1007/s00402-018-3026-6

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Keywords

  • Knee injuries
  • Knee osteoarthritis
  • Articular cartilage
  • Rehabilitation
  • Resistance training