Knee Rehabilitation Chondral Defect Surgery
Chondral defect surgery
Rehabilitation following Articular Cartilage Surgery
The rehabilitation in the acute phase is outlined perviously, and involves reducing swelling and pain and regaining motion, muscle strength, balance and co-ordination.
If the articular fragment has been reattached, post operative rehabilitation would include a period of non-weight bearing on crutches of between two to four weeks, during which time range of motion exercises are continued. Twisting motions and kneeling/squatting are prohibited to prevent shear forces across the reattached fragment for once again, between four to six weeks.
Following the two to four week period of time, weight bearing is commenced from partial to fully weight bearing as tolerated, using crutches. The rehabilitation is progressed to increase strength, balance and coordination using physiotherapy modalities and exercise/gym equipment.
With an attached bony fragment, this should certainly heal to the underlying bone bed within six weeks. The articular cartilage reattachment on its own without a bony fragment can take up to eight to twelve weeks. Twisting, turning and impact sports are usually gently recommenced from about three months onwards depending on the underlying surgery and aetiology of the osteochondral injury.
In the chronic situation following articular cartilage debridement, microfracture, mosaicplasty or chondrocyte transplantation, once again the initial rehabilitation involves reducing swelling and controlling pain with the use of anti-inflammatories, a TED stocking and a Cryocuff.
The patient is mobilised non-weight bearing for a period of two to six weeks, dependent on the size and depth of the lesion. Once this period is over, increased weight bearing is commenced over a period one to two weeks, and increasing resistive non-impact loading exercises are continued. Twisting and pivoting sports are generally returned to within three to five months, dependent upon the completion of appropriate muscle strengthening, balance and co-ordination exercises, as well as progressing through a sports specific rehabilitation programme.
If there is an associated ligament injury, such as an anterior cruciate ligament injury, I usually will not reconstruct this at the same time as treating the articular cartilage injury. The reason for this is because the rehabilitation is contradictory for the two conditions, and it is important not to jeopardise the rehabilitation of one condition due to a concurrent treatment that has been undertaken for something else. Therefore the articular cartilage lesion can be treated and rehabilitated. Once this has been done, the cruciate ligament reconstruction and/or treatment of the patello-femoral joint, can be undertaken.
In certain situations following treatment of an osteochondral injury, it may be appropriate to use an offloading brace (show picture), which diminishes the force on the appropriate compartment of the knee, where the osteochondral damage occurred and mobilisation may be commenced at an earlier stage. The problems with an offloading brace are that it can be quite uncomfortable, and can cause pressure over the knee where the forces are applied to offload the knee. It can also cause reduction in knee movement, if the range of motion exercises are carried out in the brace. The braces are also expensive.
Following successful microfracture, articular cartilage infill can occasionally be demonstrated on a high resolution MRI scan (show picture of post microfracture, lateral femoral condyle, 3T MRI scan). This can also be demonstrated following articular cartilage transplantation (show picture).
