Implementing one standardized rehabilitation protocol following autologous chondrocyte implantation or microfracture in the knee results in comparable physical therapy management.
OBJECTIVE
The major aim of the study was (1) to compare the physiotherapy management in patients treated with autologous chondrocyte implantation (ACI) versus microfracture (MF) at the knee using a standardized rehabilitation protocol; and (2) to investigate the effect of activities in low-load conditions after surgery on the functional recovery was explored.


METHODS
95 physiotherapists received a standardized rehabilitation protocol that was used in a randomized controlled trial. A secondary analysis on patients' outcome was studied in a cohort design.


METHODS
An electronic report form including 18 physiotherapy variables was used to compare physiotherapy management. Patients' functional outcome was assessed using the KOOS (Knee Injury Osteoarthritis Outcome Score) and the pooled symmetry index (SI) based on one strength and three hop tests. Both subjective and objective outcomes were evaluated pre-surgery, and at 1 and 2 years post-surgery.


RESULTS
65 physiotherapists adhered very consistently to the protocol during the first 3 months and showed a similar preference and timing for the physiotherapy modalities in both treatment groups. Patients with high amount of low-load activities (LLA+, n=21) post-surgery performed significantly better compared to patients with low amount of LLA (LLA-, n=17). At 24 months the mean pooled SI of LLA+ cohort was 92.4 compared to 78.2 for LLA- cohort (95% confidence interval [CI] 1.8 to 26.2).


CONCLUSIONS
Overall, the compliance post-surgery with the rehabilitation protocol was excellent and the applied rehabilitation was comparable in both treatment groups. A high amount of low-load activities post-surgery appears beneficial for the objective functional outcome.
Assche
Dieter Van
DV
Division of Rheumatology and Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium. Dieter.vanassche@uzleuven.be
Caspel
Danny Van
DV
Staes
Filip
F
Saris
Daniel B
DB
Bellemans
Johan
J
Vanlauwe
Johan
J
Luyten
Frank P
FP
D000328:Adult; D054544:Arthroplasty, Subchondral; D001530:Belgium; D019902:Chondrocytes / Q000637:transplantation*; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D053580:Muscle Strength; D009426:Netherlands; D010349:Patient Compliance; D026741:Physical Therapy Modalities / Q000592:standards*; D020127:Recovery of Function; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016474:Weight-Bearing