How long does it take to recover after the arthroscopic cartilage repair of the knee. Criteria based recovery plan

Abstract

Introduction Local knee cartilage defects are often found in relatively young physically active patients. Articular cartilage damage is often associated with significant discomfort such as pain, swelling, and functional impairment (Heir et al. 2010). Associated risk factors for the development of premature osteoarthritis (OA) include the size, depth, and localization of the defect, as well as possible additional injuries to knee protective structures, such as ligaments, the meniscus, or other comorbidities like axial or patellar malalignment (Khella et al, 2021). The rehabilitation the essential part of the whole treatment process. Variables that must be considered when designing postoperative rehabilitation protocols following articular cartilage procedures: lesion location, size depth, containment, quality of surrounding tissue, patient age, body mass index, general health, nutrition, quality of articular cartilage, previous activity level, specific goals, motivation level, surgery repair procedure, tissue involvement and concomitant procedures (Reinold et al, 2006). Aims and objectives The aim of this research is to make an overview of the rehabilitation programs and describe the main criteria for successful recovery after the cartilage repair procedures of the knee for the physically active patients. Materials and methods. Analysis of the scientific papers and clinical experience in the rehabilitation of the patients after the regenerative cartilage knee surgery Results The rehabilitation before the regenerative cartilage surgery is called prehabilitation. Preoperative quadriceps strength, neuromuscular control, and general fitness are considered the most important factors in the postoperative functional ability of patients with focal cartilage defects in the knee. To increase muscular strength, strength training novices are required to participate in at least 2, ideally 3 training sessions per week. In trained or athletic populations, the number of training units should be raised to 4 to 6 times per week. The minimum total time to achieve strength gain is 4–6 weeks, which induces an increase in maximum contractile muscle force mainly due to neuronal adaptations. Structural changes in the muscle architecture including muscle fibre hypertrophy can be expected after 3 months (Hirschmuller et al. 2019). The criteria for the progression of rehabilitation are pain intensity and localization of pain and swelling (at rest or at night; during passive and active movements, weight – bearing or non weight bearing). Special attention should be made to fever and risk of infection. Conclusions The main criteria-based steps for rehabilitation progression: prehabilitation (exercises before the surgery), education of the patient (daily activities and limitations), control of pain, edema and range of motion (continuous passive motion device), progression from non-weight bearing exercises to weight bearing activities, progress from open kinetic chain to closed kinetic chain exercises, fully restored the strength of the muscles before loading the joint, load the joint, get neuromuscular control, balance, complexity and variability of the movements. Statistically significant and clinically meaningful improvements in clinical parameters from the pre-operative status were achieved as early as 3 months after treatment (first time point measured) and were maintained through month 24. The primary study endpoint was met in a confirmatory manner from month 3 onward to month 24 (Niemeyer et al. 2022).