Postoperative Management for Articular Cartilage Surgery in the Knee

AbstractThe postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients. These key principles consist of preoperative assessments that include physical, mental, and behavioral components critical to recovery; education and counseling with respect to expectations and compliance; and careful monitoring and adjustments throughout the rehabilitation period based on consistent communication among rehabilitation, surgical, and imaging teams to ensure strict patient compliance with restrictions, activities, and timelines to optimize functional outcomes after surgery.

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Effects of Compliance With Procedure-Specific Postoperative Rehabilitation Protocols on Initial Outcomes After Osteochondral and Meniscal Allograft Transplantation in the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119884291 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988429 ◽

Cited By ~ 11

Author(s):

Kylee Rucinski ◽

James L. Cook ◽

Cory R. Crecelius ◽

Renée Stucky ◽

James P. Stannard

Keyword(s):

Risk Factors ◽

Postoperative Management ◽

Modifiable Risk Factors ◽

Failure Rates ◽

Meniscal Allograft Transplantation ◽

Postoperative Rehabilitation ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Management Protocol ◽

Rehabilitation Protocols

Background: Osteochondral and meniscal allograft transplantation have been performed in the knee for more than 40 years, with the number of patients treated each year growing as allograft quantity and quality increase. To date, the effects of postoperative management on outcomes after these procedures have received relatively little focus in the peer-reviewed literature. Hypothesis: Compliance with the recommended postoperative management protocol will be associated with significantly higher initial success and significantly lower revision and failure rates for patients undergoing osteochondral and/or meniscal allograft transplantation in the knee. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled into a dedicated registry designed to follow outcomes after osteochondral and/or meniscal allograft transplantation. Patients were included when at least 1 year of follow-up data were available, including data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures, based on the electronic medical record and communication logs with patients’ outpatient physical therapists. Results: For patients meeting the inclusion criteria (N = 162), compliance with the prescribed procedure-specific postoperative management protocol was associated with significantly higher 1- to 3-year success and significantly lower revision and failure rates. Specifically, patients who were compliant were 6.3 times less likely to need allograft revision or total knee arthroplasty and 7.5 times more likely to have a successful outcome at 1 to 3 years after osteochondral and/or meniscal allograft transplantation. In addition to noncompliance, older patient age and higher body mass index were associated with inferior short-term outcomes in this cohort. Conclusion: These data suggest that compliance with procedure-specific postoperative rehabilitation protocols is associated with higher success, lower revision, and lower failure rates for patients undergoing osteochondral and meniscal allograft transplantation. Given these results showing the importance of these modifiable risk factors, our center has devoted resources to preoperative patient assessment and communication to provide education, set appropriate expectations, identify and address modifiable risk factors, impediments, and noncompliance, and monitor and adjust postoperative care as indicated.

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Postoperative Rehabilitation Protocols for Achilles Tendon Ruptures: A Meta-analysis

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70180-9 ◽

2007 ◽

Vol 2007 ◽

pp. 179

Author(s):

B.F. Morrey

Keyword(s):

Achilles Tendon ◽

Meta Analysis ◽

Postoperative Rehabilitation ◽

Rehabilitation Protocols ◽

Tendon Ruptures

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Patient-Specific Factors Drive Intensive Care Unit and Total Hospital Length of Stay in Operative Brain Tumor Patients

World Neurosurgery ◽

10.1016/j.wneu.2021.06.114 ◽

2021 ◽

Author(s):

Adrian E. Jimenez ◽

Pavan P. Shah ◽

Adham M. Khalafallah ◽

Sakibul Huq ◽

Jose L. Porras ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Brain Tumor ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Patient Specific ◽

Total Hospital ◽

Tumor Patients ◽

Specific Factors

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Commentary: One size fits some—additional pulmonary blood flow at the Glenn operation and patient-specific factors

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.01.082 ◽

2021 ◽

Author(s):

Neel K. Prabhu ◽

Nicholas D. Andersen ◽

Joseph W. Turek

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Patient Specific ◽

Specific Factors

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Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among polish arthroscopy society members

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03649-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Paweł Bąkowski ◽

Kamilla Bąkowska-Żywicka ◽

Tomasz Piontek

Keyword(s):

Knee Arthroscopy ◽

Full Range ◽

Postoperative Management ◽

Meniscus Repair ◽

Postoperative Treatment ◽

Meniscus Tear ◽

Postoperative Rehabilitation ◽

Meniscus Suture ◽

Surgical Expertise ◽

Almost All

Abstract Background Meniscus repair is a challenging task in knee arthroscopy. Currently, there are a variety of arthroscopic methods available for meniscus repair. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopaedists. Methods A total of 205 registered orthopaedic surgeons participated in the surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physicians’ level of expertise, anaesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care. Results The most important finding of this study was the agreement among almost all aspects of the knee arthroscopy approach. Consensus among Polish surgeons was noticed in choosing regional anaesthesia for knee arthroscopy, the lack of need for knee braces and knee medications, the of use of LMW heparin for thromboprophylaxis, 1–2 days of hospitalization, the recommendation of rehabilitation and the use of magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus suture procedures (p = 0.009). Experts recommended starting rehabilitation on the day of surgery (p = 0.007) and were more likely to use objective physical tests (p = 0.003). Non-expert surgeons recommended a longer period from meniscus suture to full-range knee motion (p = 0.001) and admitted that patient age does matter for meniscus repair qualification (p = 0.002). Conclusions There is consensus among almost all issues of meniscus tear treatment in the environment of Polish orthopaedists; however, the issues of rehabilitation and the use of advanced meniscus repair techniques are associated with surgical expertise.

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Towards Patient-Specific Computational Modelling of Articular Cartilage on the Basis of Advanced Multiparametric MRI Techniques

Scientific Reports ◽

10.1038/s41598-019-43389-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Kevin Linka ◽

Amelie Schäfer ◽

Markus Hillgärtner ◽

Mikhail Itskov ◽

Matthias Knobe ◽

...

Keyword(s):

Articular Cartilage ◽

Computational Modelling ◽

Multiparametric Mri ◽

Patient Specific

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Microfracture for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Survey of International Cartilage Regeneration & Joint Preservation Society

Cartilage ◽

10.1177/1947603520954503 ◽

2020 ◽

pp. 194760352095450

Author(s):

Jesus Medina ◽

Ignacio Garcia-Mansilla ◽

Peter D. Fabricant ◽

Thomas J. Kremen ◽

Seth L. Sherman ◽

...

Keyword(s):

Surgical Technique ◽

Regional Differences ◽

Current Practice ◽

Cartilage Regeneration ◽

Postoperative Management ◽

Cartilage Lesions ◽

Significant Difference ◽

Rehabilitation Protocols ◽

Joint Repair ◽

Vertical Walls

Objective The purpose of this study was to describe the current practice trends for managing symptomatic cartilage lesions of the knee with microfracture among ICRS (International Cartilage Regeneration & Joint Repair Society) members. Design A 42-item electronic questionnaire was sent to all ICRS members, which explored indications, surgical technique, postoperative management, and outcomes of the microfracture procedure for the treatment of symptomatic, full thickness chondral and osteochondral defects of the knee. Responses were compared between surgeons from different regions and years of practice. Results A total of 385 surgeons answered the questionnaire. There was a significant difference noted in the use of microfracture among surgeons by region ( P < 0.001). There was no association between the number of years in practice and the self-reported proportion of microfracture cases performed ( P = 0.37). Fifty-eight subjects (15%) indicated that they do not perform microfracture at all. Regarding indication for surgery, 56% of surgeons would limit their indication of microfracture to lesions measuring 2 cm2 or less. Half of the surgeons reported no upper age or body mass index limit. Regarding surgical technique, 90% of surgeons would recommend a formal debridement of the calcified layer and 91% believe it is important to create stable vertical walls. Overall, 47% of surgeons use biologic augmentation, with no significant difference between regions ( P = 0.35) or years of practice ( P = 0.67). Rehabilitation protocols varied widely among surgeons. Conclusions Indications, operative technique, and rehabilitation protocols utilized for patients undergoing microfracture procedures vary widely among ICRS members. Regional differences and resources likely contribute to these practice pattern variations.

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Post-operative rehabilitation and nutrition in osteoarthritis

F1000Research ◽

10.12688/f1000research.4178.3 ◽

2016 ◽

Vol 3 ◽

pp. 116 ◽

Cited By ~ 4

Author(s):

Giuseppe Musumeci ◽

Ali Mobasheri ◽

Francesca Maria Trovato ◽

Marta Anna Szychlinska ◽

Rosa Imbesi ◽

...

Keyword(s):

Articular Cartilage ◽

Physical Exercise ◽

Structural Changes ◽

Exercise Program ◽

Structural Features ◽

Synovial Joint ◽

Comprehensive Overview ◽

Postoperative Rehabilitation ◽

Keywords Osteoarthritis ◽

Rehabilitation Exercise

Osteoarthritis (OA) is a degenerative process involving the progressive loss of articular cartilage, synovial inflammation and structural changes in subchondral bone that lead to loss of synovial joint structural features and functionality of articular cartilage. OA represents one of the most common causes of physical disability in the world. Different OA treatments are usually considered in relation to the stage of the disease. In the early stages, it is possible to recommend physical activity programs that can maintain joint health and keep the patient mobile, as recommended by OA Research Society International (OARSI) and European League Against Rheumatism (EULAR). In the most severe and advanced cases of OA, surgical intervention is necessary. After, in early postoperative stages, it is essential to include a rehabilitation exercise program in order to restore the full function of the involved joint. Physical therapy is crucial for the success of any surgical procedure and can promote recovery of muscle strength, range of motion, coordinated walking, proprioception and mitigate joint pain. Furthermore, after discharge from the hospital, patients should continue the rehabilitation exercise program at home associated to an appropriate diet. In this review, we analyze manuscripts from the most recent literature and provide a balanced and comprehensive overview of the latest developments on the effect of physical exercise on postoperative rehabilitation in OA. The literature search was conducted using PubMed, Scopus, Web of Science and Google Scholar, using the keywords ‘osteoarthritis’, ‘rehabilitation’, ‘exercise’ and ‘nutrition’. The available data suggest that physical exercise is an effective, economical and accessible to everyone practice, and it is one of the most important components of postoperative rehabilitation for OA.

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Successful recanalization for acute ischemic stroke via the transbrachial approach

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011451 ◽

2014 ◽

Vol 8 (2) ◽

pp. 122-125 ◽

Cited By ~ 13

Author(s):

Masakazu Okawa ◽

Satoshi Tateshima ◽

David Liebeskind ◽

Latisha K Ali ◽

Michael L Thompson ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Patient Specific ◽

Ischemic Stroke Patient ◽

Transfemoral Approach ◽

Acute Ischemic Stroke Patient ◽

Transbrachial Approach ◽

Stent Retrievers ◽

Endovascular Approach ◽

Specific Factors

The recent development of revascularization devices, including stent retrievers, has enabled increasingly higher revascularization rates for arterial occlusions in acute ischemic stroke. Patient-specific factors such as anatomy, however, may occasionally limit endovascular deployment of these new devices via the conventional transfemoral approach. We report three cases of acute ischemic stroke where a transbrachial endovascular approach to revascularization was used, resulting in successful recanalization. These examples suggest that a transbrachial approach may be considered as an alternative in the endovascular treatment of acute ischemic stroke.

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