Skip to main content

Advertisement

SpringerLink
Log in

Rehabilitation following osteochondral injury to the knee

  • Knee Rehabilitation (J Cavanaugh, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Articular cartilage injuries of the knee can be debilitating if not treated properly. Once an articular cartilage injury is sustained there are a variety of surgical interventions depending on the severity of the injury. The most common of these procedures are: osteochondral autograft transplantation (OATS), autologous chondrocyte implantation (ACI) and microfracture. The rehabilitation outlined in this article is specific to the exact surgical procedure performed and the location in the knee. The outcomes of these procedures are also discussed.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31, 516 knee arthroscopies. Arthroscopy. 1997;13:456–60.

    Article  PubMed  CAS  Google Scholar 

  2. Aroen A, Loken S, Heir S, et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004;32:211–5.

    Article  PubMed  Google Scholar 

  3. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002;18:730–4.

    Article  PubMed  Google Scholar 

  4. Piasecki DP, Spindler KP, Warren TA, Andrish JT, Parker RD. Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes: an analysis of sex-based differences. Am J Sports Med. 2003;31:601–5.

    PubMed  Google Scholar 

  5. Shelbourne KD, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg [Am]. 2003;85-A Suppl 2:8–16.

    Google Scholar 

  6. Insall J. The Pridie debridement operation for osteoarthritis of the knee. ClinOrthopRelat Res. 1974;101:61–7.

    Google Scholar 

  7. Steadman JR, Rodkey WG, Briggs KK, Rodrigo JJ. The microfracture procedure: rationale, technique, and clinical observations for treatment of articular cartilage defects. J Sports Traumatolrel Res. 1998;20(2):61–70.

    Google Scholar 

  8. Mithoefer K, Williams 3rd RJ, Warren RF, Wickiewicz TL, Marx RG. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med. 2006;34(9):1413–8.

    Article  PubMed  Google Scholar 

  9. Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy. 2006;22(11):1180–6.

    Article  PubMed  Google Scholar 

  10. Mithoefer K, Williams 3rd RJ, Warren RF, et al. Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg Am. 2006;88 suppl 1:294–304.

    Article  PubMed  Google Scholar 

  11. Gill TJ, McCulloch PC, Glasson SS, Blanchet T, Morris EA. Chondral defect repair after the microfracture procedure: a nonhuman primate model. Am J Sports Med. 2005;33(5):680–5.

    Article  PubMed  Google Scholar 

  12. Honig K, Vidal A, McCarty E. Microfracture. Tech Knee Surg. 2009;8:7–13.

    Article  Google Scholar 

  13. Rodrigo JJ, Steadman JR, Silliman JF, Fulstone HA. Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg. 1994;7(3):109–16.

    Google Scholar 

  14. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477–84.

    Article  PubMed  Google Scholar 

  15. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports TraumatolArthrosc. 2005;13:213–21.

    Article  Google Scholar 

  16. Yamashita F, Skakida K, Suzu F, et al. The transplantation of an autogeneic osteochondral fragment for osteochondritisdissecans of the knee. ClinOrthopRelat Res. 1985;201:43–50.

    Google Scholar 

  17. Feeley BT, Rodeo SA. Osteochondral allograft transplantation. Tech Knee Surg. 2009;8:22–8.

    Article  Google Scholar 

  18. Matsusue Y, Kubo M, Nakagawa Y. Autogenous bone-cartilage transplantation. Tech Knee Surg. 2010;9:85–94.

    Article  Google Scholar 

  19. Reddy S, Ma B, Feeley BT. Autologous osteochondral grafting of articular lesions in the knee. Tech Knee Surg. 2009;8:14–21.

    Article  Google Scholar 

  20. Whiteside RA, Bryant JT, Jakob RP, Mainil-Varlet P, Wyss UP. Short term load bearing capacity of osteochondral autografts implanted by the mosaicplasty technique: an in vitro porcine model. J Biomech. 2003;36:1203–8.

    Article  PubMed  CAS  Google Scholar 

  21. Hangody L, Kish G, Karpati Z. Autogenous osteochondral graft technique for replacing knee cartilage defects in dogs. Orthop Int. 1997;5:175–81.

    Google Scholar 

  22. • Lahav A., Burks RT., Greis PE., Chapman AW., Ford GM., Fink BP.: Clinical outcomes following osteochondral autologous transplantation (OATS).J Knee Surg. 2006 Jul;19(3):169-73. This study demonstrates that osteochondral autologous transplantation (OATS) is an option for articular resurfacing of the femoral condyles for focal areas of chondral defects with promising results.

    PubMed  Google Scholar 

  23. Hangody L, Vasarhelyi G, Hangody LR, et al. Autologous osteochondral grafting –technique and long term results. Injury. 2008;39 suppl 1:S32–9.

    Article  PubMed  Google Scholar 

  24. Jakob RP, Franz T, Gautier E, Mainil-Varlet P. Autologous osteochondral grafting in the knee: indications, results and reflections. ClinOrthopRelat Res. 2002;401:170–84.

    Google Scholar 

  25. Marcacci M, Kon E, Delcogliano M, et al. Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: prospective study results at a minimum 7- year follow-up. Am J Sports Med. 2007;35:2014–21.

    Article  PubMed  Google Scholar 

  26. Min BH, Oh KS. Autologous Chondrocyte Implantation. Tech Knee Surg. 2010;9:66–79.

    Article  Google Scholar 

  27. Jones DG, Peterson L. Autologous chondrocyte implantation. J Bone Joint Surg Am. 2006;88:2502–20.

    Article  PubMed  Google Scholar 

  28. Kon E, Gobbi A, Filardo G, et al. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J of Sports Med. 2009;37:33–41.

    Article  Google Scholar 

  29. Tohyama H, Yasuda K, Minami A, et al. Atelocollagen-associated autologous chondrocyte implantation for the repair of chondral defects of the knee: a prospective multicenter clinical trial in japan. J Orthop Sci. 2009;14:579–88.

    Article  PubMed  CAS  Google Scholar 

  30. Carey-Smith R, Ebert J, Davies H, et al. Arthroscopic matrix-induced autologous chondrocyte implantation: a simple surgical technique. Tech Knee Surg. 2010;9:170–5.

    Article  Google Scholar 

  31. Jones DG, Peterson L. Autologous Chondrocyte Implantation. J Bone Joint Surg Am. 2006;88:2502–20.

    Article  PubMed  Google Scholar 

  32. O’Driscoll SW, Salter RB. The repair of major osteochondral defects in joint surfaces by neochondrogenesis with autogenousosteoperiosteal grafts stimulated by continuous passive motion. An experimental investigation in the rabbit. ClinOrthopRelat Res. 1986;208:131–40.

    Google Scholar 

  33. Kreuz PC, Steinwachs M, Erggelet C, et al. Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year follow-up. Am J Sports Med. 2007;35:1261–8.

    Article  PubMed  Google Scholar 

  34. Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G, et al. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 2005;21(9):1066–75.

    Article  PubMed  Google Scholar 

  35. • Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas R. A Prospective, Randomized Clinical Study of Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of OsteochondritisDissecans in the Knee Joint in Children. PediatrOrthop. 2009:29:741–748. This clinical, level 1 study in young active athletes under the age of 40 showed significant advantage of OATS over MF for the repair of articular cartilage defects in the knee. The authors found that only 52% of MF athletes could return to sports at the preinjury level compared to 93% of OATS.

    Google Scholar 

  36. Harris J, Brophy R, Siston R, Flanigan D. Treatment of chondral defects in the athlete’s knee. Arthroscopy. 2010;26:841–52.

    Article  PubMed  Google Scholar 

  37. Burns T, Giuliani J, Svoboda S, Owens B. Knee caritlagetibio-femoral injuries. Tech Orthop. 2010;25:208–16.

    Article  Google Scholar 

  38. • Reinold MM, Wilk KE, Maacrina LC, et al. Current Concepts in the rehabilitation following articular cartilage repair procedures in the knee. J Orthop Sports PhysTher. 2006;36:774–794. This paper provides an excellent adjunct to the current paper and an overview the principles of rehabilitation following articular cartilage repair procedures. It includes specific rehabilitation guidelines following surgery based upon the current understanding of the biological healing response postoperatively.

    Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Nicholas Institute for Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York, NY, USA

    Timothy F. Tyler

  2. PRO Sports Physical Therapy, 2 Overhill Road, Scarsdale, NY, 10583, USA

    Timothy F. Tyler & Jennifer Y. Lung

Authors
  1. Timothy F. Tyler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Y. Lung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy F. Tyler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tyler, T.F., Lung, J.Y. Rehabilitation following osteochondral injury to the knee. Curr Rev Musculoskelet Med 5, 72–81 (2012). https://doi.org/10.1007/s12178-011-9108-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-011-9108-5

Keywords

Search

Navigation