Surgical options for early arthritis in young persons and athletes: the role of meniscus transplants, microfracture, Osteoarticular Transplants (OATs), Autologous Chondrocyte Implantation (ACI) and osteotomy
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, June 30, 2006
RehabilitationPhysical therapy Early motion is critical after the articular cartilage
procedures, but unrestricted motion can endanger the success of the
procedure. For the first 2 weeks, the
patient spends about 6-8 hours per day on the CPM machine to retain and regain
motion. After the wounds have begun
healing, the patient is scheduled to see a physical therapist twice or three
times per week to monitor the progress of healing, teach the proper exercises,
and guide the patient in a strengthening program.
After two weeks, a more comprehensive rehabilitation
program is started. During this period,
the therapist works closely with the patient to re-establish a normal range of
motion. The therapist and patient work
together, but the patient is expected to do “homework” on a daily basis so that
constant improvement is achieved. Once a
normal range of motion is re-established, knee strengthening is started. It takes about 12 weeks before the knee is
completely rehabilitated for the normal activities of daily living, and about 9
to 12 months before low-impact sports can be re-started. At our institution, we utilize athletic trainers
to work with patients on “sports-specific” training to re-train the muscles and
knee for golf, tennis, running, cutting, and swimming. Rehabilitation options The results of physical therapy are optimized by a competent
therapist, familiar with the procedure and the usual expectations, and a compliant
patient, who does home exercises and is motivated to improve. Most surgeons have a standard protocol that
they can give to a physical therapist to let them know how to rehabilitate the
knee. It is important for a patient to
find a therapist with flexible hours and a convenient location because the
therapy will become part of a routine for 4 to 9 months. The surgeon can recommend a therapist or
therapy group with whom he or she is used to working and who is familiar with
the procedure. Therapy is generally done
on an outpatient basis, with 2 or 3 visits per week so that the therapist can
check the progress and review or modify the program as needed to suit the
individual.Usual response
Patients are almost always satisfied with the range of motion, comfort, and function that they achieve as the rehabilitation program progresses. Some patients will lose a slight degree of knee motion (the ability to bring the heel to the buttock), but this does not usually interfere with daily activities or sports. Occasionally, the knee may retain a slight degree of discomfort with activities compared to the other knee, although this is usually minimal and does not require bracing. Alternatively, the knee can become stiff after surgery. Many patients are encouraged to return to non-impact athletics, such as cycling, swimming, climbing, cross-country skiing, snowshoeing, etc. Risks There are very few risks to appropriate postoperative
therapy. If the therapist and surgeon do
not communicate about what exactly what was done and what the short- and
long-term expectations are following the procedure, the therapist can be too
aggressive or too timid about the rehabilitation. This can result in mild knee stiffness or
laxity. When the patient, physician, and
rehabilitation specialist are in good communication regarding the timing and
expectations of the rehabilitation process, the results are usually excellent. Duration of rehabilitation Every patient is slightly different. Once the range of motion is acceptable and
the strength has returned, the rehabilitation program can be cut back to a
minimal level. Patients who have special
needs, such as cutting athletes, runners, and heavy laborers, may require
sports-specific training or “work hardening” with a therapist or athletic
trainer. Frequently, the surgeon will
discourage heavy labor and impact or cutting athletics after the reconstruction
of large cartilage defects. Returning to ordinary daily activities In general, patients are able to resume activities of
daily living using crutches or a walker within 3 to 4 weeks after surgery if a
weight-bearing joint (knee or ankle) is involved. Most persons who work at a desk job can
return to work during this time. The
patient is strongly encouraged to avoid weight-bearing at all times for the
first 6 to 8 weeks. After this time, the
patient is gradually advanced to full weight bearing. Athletics are discouraged until about 9
months post-op.
Driving should wait until the patient can perform the
necessary functions comfortably and confidently, pain is at a minimum, and pain
medications are not required. A good
question to ask a patient is, “Would you want you driving if your 4-year old
child was in the car or playing in the street?” In general, it may take longer for a person
to drive after the right knee has undergone surgery because of the increased
demands on the right leg for driving.
With the consent of
their surgeon, a patient may return to activities such as swimming and golf
between 4 and 6 months following the procedure.
More extreme sports (wrestling, running, hiking on uneven ground,
soccer, basketball, etc) should only be undertaken after at least 9 months of
rehabilitation, when the knee is extremely comfortable and the strength is 90
percent of the uninjured knee. Such
sports may be discouraged by your surgeon. Long-term patient limitations After the appropriate procedure and a comprehensive
rehabilitation have been completed, most patients can return to work and
non-impact athletics without disability.
Depending on the procedures performed, concomitant injuries, and the
stability of the knee, many patients will choose to return to cutting athletics
such as basketball, football, or skiing.Costs The surgeon and therapist should provide the information
of the usual cost of the rehabilitation program. Most insurance policies will cover the costs
of some or most of the rehabilitation.
Careful adherence to at-home exercises between visits will usually
decrease the overall number and frequency of visits required.Surgery for Arthritis, osteochondral defects (OCD lesions), meniscus transplantation and cartilage loss in the knee. at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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