Global Clinician Panel Publishes New Consensus Document On Cartilage And Meniscal Rehabilitation
A global panel of nearly 50 orthopaedic experts has developed the first consensus document recommending rehabilitation protocols for patients recovering from knee cartilage-related injuries, including contained and uncontained cartilage defects, and meniscal repair or transplantation.
The recommendations reflect the input of thought-leaders from several orthopaedic disciplines who attended the 1st Global Cartilage Expert Consensus Meeting last Fall. The event was chaired by Prof. Jörg Jerosh, Dr. Dr. h.c., of Johanna-Etienne Hospital, Neuss Germany, and sponsored by Össur, a global innovator in prosthetic and orthopaedic technologies.
Over two days, clinicians explored a variety of topics, including developments in cartilage and meniscal repair techniques, the potential of future therapies such as stem cells for treating cartilage injuries, and the importance of alignment in cartilage repair. They also participated in workshops where they developed treatment recommendations for patients recovering from cartilage or meniscal repair procedures.
Among the presenters was pioneering orthopaedic surgeon Dr. Robert LaPrade of the Steadman Clinic in Denver, Colorado, who reflected on two decades of experience in performing osteoarticular allograft surgery, which he characterized as “still the gold standard” of care.
““A meeting like this is very important because we had several generations of surgeons here,”Dr. LaPrade said.“Some of us were involved in the infancy of the ACI procedure. We have seen some patients have problems with post-operative rehabilitation by not using bracing. For the newer generation of surgeons to be able to see how we treat patients and use that as part of their practice could help them advance their care of patients.””
Consensus Recommendations: Contained Cartilage Lesion
Clinical experts reviewed existing literature regarding current rehabilitation protocols as well as results of a questionnaire that had been administered prior to the conference. They then considered rehab practices for patients who had a contained, full thickness cartilage lesion and had undergone surgical treatment.
The panel’s recommendations included specific details related to weight-bearing, range-of-motion (ROM) bracing, and physical therapy, to be conducted in four phases over an approximately 13-week period. An unloading knee brace, such as Össur’s Rebound® Cartilage brace, which was designed to provide immobilization, ROM restriction and unloading of the repaired femoro-tibial compartment, was recommended as part of the treatment protocol.
Consensus Recommendations: Poorly Contained Cartilage Lesion
A second panel of clinical experts evaluated post-op rehab options for patients with poorly contained or larger cartilage lesions. Their recommendations, which spanned four phases over a 26-week period, included progressive weight-bearing and ROM restrictions corresponding to patients’ abilities and pain tolerance.
The panel recommended bracing throughout the recovery process, first for immobilization and, later to perform unloading, such as seen in Össur’s Rebound Cartilage, as patients resumed full activity. A phased approach to physiotherapy was also recommended. The panel also encouraged consideration of prophylactic medications to minimize patients’ risk of developing deep vein thrombosis (DVT), particularly during the first 12 weeks post-operatively.
Consensus Recommendations on Rehabilitation Following Meniscal Tears
A third panel of clinical experts acknowledged that meniscal injuries can be particularly concerning because inadequate management in younger patients increases their risk for developing osteoarthritis (OA) later in life. They also noted considerable variability in rehabilitation protocols for meniscal tears, and the absence of a consensus approach. In developing their recommendations, this panel considered scenarios in which a patient might have suffered a bucket handle tear, a radial meniscal tear, and a lateral/medial meniscal root tear.
This panel envisioned five phases of recovery, encompassing approximately 26 weeks. Conservative weight-bearing was recommended, progressing according to patients’ tolerance. Bracing with an Unloader brace, such as Össur’s Unloader® One, was recommended for rehabilitation of radial and meniscal root tears to ensure protection of the healing meniscus. The panel expressly prohibited deep squats during the early phases of recovery, and loaded squats until patients had free range of motion.
The panel also recommended a progressive approach to physiotherapy. This included isometric exercises and cryotherapy in early phases, followed by increasing strength, balance and endurance activities. Finally, this panel also recommended considering prophylaxis to minimize patients’ DVT risk, especially in the first 12 weeks of their recovery.
Read the protocol here.
Rebound Bracing: Recommended by Global Experts
As a company, Össur has developed a number of innovative braces to help orthopaedic patients, including those recovering from cartilage injuries. These include immobilizing and ROM-restricting technologies, such as Össur’s Formfit Knee Immobilizer® and the intuitive Rebound Post-Op Knee brace, as well as the Rebound Cartilage brace, which has been designed to provide dynamic and adjustable unloading to the affected joint.
“Bracing is often indicated for patients with cartilage injuries,”said Dr. Axel Schulz, Össur’s Medical Director.“Our hope is that these consensus documents provide guidance for doctors all over the world when recommending rehabilitation for their patients, including the appropriate use of bracing.”