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

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University of Freiburg, Medical Center, Freiburg, Germany

    Anja Hirschmüller, Wolfgang Schoch, Lukas Konstantinidis, Nobert P. Südkamp & Philipp Niemeyer

  2. Altius Swiss Sportmed Center AG, Rheinfelden, Switzerland

    Anja Hirschmüller

  3. PULZ Physiotherapie und Lauftherapie Zentrum, Freiburg, Germany

    Wolfgang Schoch

  4. Bern University of Applied Sciences, Health, Physiotherapy, Bern, Switzerland

    Heiner Baur

  5. Center for Joints and Cartilage, Department of Traumatology, Medical University of Vienna, Vienna, Austria

    Barbara Wondrasch

  6. OCM Orthopädische Chirurgie München, Munich, Germany

    Philipp Niemeyer

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  1. Anja Hirschmüller
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  2. Wolfgang Schoch
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  3. Heiner Baur
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Correspondence to Heiner Baur.

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Appendix: Prehabilitation program

Appendix: Prehabilitation program

Warm up

Fig. 1
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Stationary bike

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Treadmill

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Sensorimotor exercises

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

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Bench alternate legs

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Sideway bench static

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Single-leg toe touch

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Single-leg toe touch adding an Airex® pad

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Squats

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Squats with toe raise

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Lunges

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Vertical jumps

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Fig. 11
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Side to side-bounds

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Strength training

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

Fig. 12
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One-leg leg press (45° position)

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One-leg leg curl: leg extension

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One-leg leg curl: leg flexion

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Fig. 15
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Nordic hamstrings

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Fig. 16
figure 16

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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