Rebound® Cartilage Case Study
Female patient with chronic pain in left knee.
Peter Verdonk
MD, PhD
Antwerp Orthopaedic Center Monica Hospitals
Department of Orthopaedic Surgery Antwerp University Hospital (UZA)
Indication
Female patient, presents with chronic pain at the lateral tibiofemoral compartment of the left knee. She underwent a lateral subtotal meniscectomy 7 years ago. Clinical examination reveals slight valgus alignment of the knee. Tenderness is located at the lateral joint line, no ligament instability could be found using conventional laxity tests.
Diagnostics
Standing X-rays confirmed close to neutral alignment of the left knee (valgus angle of 1.6 degrees). Arthro-CT scans confirmed subtotal meniscal defect at the lateral side (34 mm on coronal plane, 29 mm on sagittal plane), with evidence of focal (ICRS grade III) chondral damage at the lateral tibiofemoral compartment.
Treatment Overview / Treatment Goal
Initial rehabilitation is prescribed to maintain complete range of motion and improve quadriceps strength. Lateral unloader brace was used to reduce the bearing on the lateral compartment and improve knee function as a preoperative test. Lateral meniscal allograft transplantation procedure is planned on the basis of pre-operative condition. Aim is to achieve pain-free bearing, and satisfactory knee function.
Surgical Treatment
A lateral meniscal allograft transplantation with bone trough was performed, under arthroscopic guidance.
Rehabilitation
| Item | Phase 1 (0-1W) | Phase 2 (1-3W) | Phase 3 (3-6W) | Phase 4 (>6W) |
|---|---|---|---|---|
| Rebound Cartilage | 24 hours | No bracing | During ambulation | During ambulation |
| ROM | Locked in extension | 0-45 week 1-3 | Max 90 degrees | Progression to full flexion, avoid deep flexion until week 12 |
| Weight Bearing | Not allowed | Not allowed | Progressive weightbearing | Full weightbearing with brace |
| Physical Therapy | RICE Isometric Contractions | RICE Closed chain Proprioception | Progress to open chain exercises | Strengthening Proprioception |
Reasons To Use the Rebound Cartilage Brace
The brace fits optimally the needs to unload the treated compartment and to protect the transplant in the early healing phases, while allowing gradual increase of flexion during post-operative period. It also serves in the preoperative testing phase to identify mechanical overload as the main responsible factor of pain in the affected compartment.
Clinical Outcome
At 3 months of follow-up, the patient is pain free, she walks without crutches. Unrestricted activity was allowed at 6 months, but contact sports were delayed at 12 months of follow-up. MRI showed good status of the meniscal tissue, but still ongoing integration of the bone plug, that otherwise appeared well integrated at X-Ray evaluation.
Conclusion
Use of the Rebound Cartilage brace helped to unload and protect the implant during integration phases, at the same time allowing a safe recovery of the flexion, thanks to the adjustable hinge, and progression towards complete weight-bearing.
Rebound® Cartilage
The Rebound Cartilage is a protective functional solution designed to support regeneration of the knee cartilage after repair procedures such as Microfracture, OATS and (M)ACI. Based on the clinically-proven 3-Points of Leverage System and patented Cartilage Protection Straps,™ joint unloading is maintained in flexion for protection of the cartilage during the healing process.
- Unloads the affected knee compartment
- Limits ROM where required
- Provides proprioceptive control
- Lightweight w/ Sensil® liners