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Archives of Orthopaedic and Trauma Surgery

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01-02-2019 | Arthroscopy and Sports Medicine

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

Authors: Anja Hirschmüller, Wolfgang Schoch, Heiner Baur, Barbara Wondrasch, Lukas Konstantinidis, Nobert P. Südkamp, Philipp Niemeyer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2019

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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Title: Rehabilitation before regenerative cartilage knee surgery: a new prehabilitation guideline based on the best available evidence
Authors: Anja Hirschmüller
Wolfgang Schoch
Heiner Baur
Barbara Wondrasch
Lukas Konstantinidis
Nobert P. Südkamp
Philipp Niemeyer
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3026-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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