Nachbehandlung nach Knorpeltherapie am Kniegelenk – eine Empfehlung der AG Klinische Geweberegeneration der DGOU

Thomas R. Niethammer; Matthias Aurich; Peter U. Brucker; Svea Faber; Frank Diemer; Matthias F. Pietschmann; Wolfgang Schoch; Wolfgang Zinser; Peter E. Müller

doi:10.1055/a-2206-7242

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2024; 162(06): 614-622
DOI: 10.1055/a-2206-7242

Original Article

Follow-up Treatment after Cartilage Therapy of the Knee Joint – a Recommendation of the DGOU Clinical Tissue Regeneration Working Group

Article in several languages: English | deutsch

Thomas R. Niethammer

¹Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland (Ringgold ID: RIN27192)

,

Matthias Aurich

²Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle, Deutschland

³Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost, Halle (Saale), Deutschland

,

Peter U. Brucker

⁴ATOS Klinik München, München, Deutschland

⁵Biomechanik im Sport, Fakultät für Sport- und Gesundheitswissenschaft, Technische Universität München, München

,

Svea Faber

¹Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland (Ringgold ID: RIN27192)

,

Frank Diemer

⁶DIGOTOR GbR, Brackenheim, Deutschland

,

Matthias F. Pietschmann

¹Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland (Ringgold ID: RIN27192)

⁷OrthoPraxis Oberhaching, Oberhaching

,

Wolfgang Schoch

⁸PULZ im Rieselfeld, Freiburg, Deutschland

,

Wolfgang Zinser

⁹Orthoexpert, Knittelfeld, Österreich

¹⁰Metagil Physikalisches Ambulatorium, Knittelfeld, Österreich

,

Peter E. Müller

¹Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland (Ringgold ID: RIN27192)

› Author Affiliations

Abstract

The first follow-up treatment recommendation from the DGOU’s Clinical Tissue Regeneration working group dates back to 2012. New scientific evidence and changed framework conditions made it necessary to update the follow-up treatment recommendations after cartilage therapy.

As part of a multi-stage member survey, a consensus was reached which, together with the scientific evidence, provides the basis for the present follow-up treatment recommendation.

The decisive criterion for follow-up treatment is still the defect localisation. A distinction is made between femorotibial and patellofemoral defects. In addition, further criteria regarding cartilage defects are now also taken into account (stable cartilage edge, location outside the main stress zone) and the different methods of cartilage therapy (e. g. osteochondral transplantation, minced cartilage) are discussed.

The present updated recommendation includes different aspects of follow-up treatment, starting with early perioperative management through to sports clearance and resumption of contact sports after cartilage therapy has taken place.

Keywords

aftercare - cartilage therapy - knee - rehabilitation

Full Text

References

References
1 Behrens P, Bosch U, Bruns J. et al. [Indications and implementation of recommendations of the working group “Tissue Regeneration and Tissue Substitutes” for autologous chondrocyte transplantation (ACT)]. Z Orthop Ihre Grenzgeb 2004; 142: 529-539
2 Niemeyer P, Andereya S, Angele P. et al. [Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU)]. Z Orthop Unfall 2013; 151: 38-47
3 Niemeyer P, Albrecht D, Aurich M. et al. Empfehlungen der AG Klinische Geweberegeneration zur Behandlung von Knorpelschaden am Kniegelenk. Z Orthop Unfall 2023; 161: 57-64
4 Pietschmann MF, Horng A, Glaser C. et al. [Post-treatment rehabilitation after autologous chondrocyte implantation: State of the art and recommendations of the Clinical Tissue Regeneration Study Group of the German Society for Accident Surgery and the German Society for Orthopedics and Orthopedic Surgery]. Unfallchirurg 2014; 117: 235-241
5 Guenther D, Pfeiffer T, Petersen W. et al. Treatment of Combined Injuries to the ACL and the MCL Complex: A Consensus Statement of the Ligament Injury Committee of the German Knee Society (DKG). Orthop J Sports Med 2021; 9
6 Ebert JR, Edwards PK, Fallon M. et al. Two-Year Outcomes of a Randomized Trial Investigating a 6-Week Return to Full Weightbearing After Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med 2017; 45: 838-848
7 Ebert JR, Fallon M, Ackland TR. et al. Minimum 10-Year Clinical and Radiological Outcomes of a Randomized Controlled Trial Evaluating 2 Different Approaches to Full Weightbearing After Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med 2020; 48: 133-142
8 Ebert JR, Fallon M, Wood DJ. et al. An accelerated 6-week return to full weight bearing after matrix-induced autologous chondrocyte implantation results in good clinical outcomes to 5 years post-surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29: 3825-3833
9 Ebert JR, Fallon M, Zheng MH. et al. A randomized trial comparing accelerated and traditional approaches to postoperative weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation: findings at 5 years. Am J Sports Med 2012; 40: 1527-1537
10 Wondrasch B, Risberg MA, Zak L. et al. Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle: a prospective, randomized controlled study presenting MRI-based and clinical outcomes after 5 years. Am J Sports Med 2015; 43: 146-153
11 Della Villa S, Kon E, Filardo G. et al. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes?. Am J Sports Med 2010; 38: 68-77
12 Kreuz PC, Steinwachs M, Erggelet C. et al. Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year follow-up. Am J Sports Med 2007; 35: 1261-1268
13 Niethammer TR, Müller PE, Safi E. et al. Early resumption of physical activities leads to inferior clinical outcomes after matrix-based autologous chondrocyte implantation in the knee. Knee Surg Sports Traumatol Arthrosc 2014; 22: 1345-1352
14 Li M, Yin H, Yan Z. et al. The immune microenvironment in cartilage injury and repair. Acta Biomater 2022; 140: 23-42
15 Khella CM, Horvath JM, Asgarian R. et al. Anti-Inflammatory Therapeutic Approaches to Prevent or Delay Post-Traumatic Osteoarthritis (PTOA) of the Knee Joint with a Focus on Sustained Delivery Approaches. Int J Mol Sci 2021; 22: 8005
16 Scotti C, Gobbi A, Karnatzikos G. et al. Cartilage Repair in the Inflamed Joint: Considerations for Biological Augmentation Toward Tissue Regeneration. Tissue Eng Part B Rev 2016; 22: 149-159
17 Diemer F. Temperaturmessung. Sportphysio 2021; 09: 92-97
18 Hambly K, Bobic V, Wondrasch B. et al. Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. Am J Sports Med 2006; 34: 1020-1038
19 McGinty G, Irrgang JJ, Pezzullo D. Biomechanical considerations for rehabilitation of the knee. Clin Biomech (Bristol, Avon) 2000; 15: 160-166
20 Bailey A, Goodstone N, Roberts S. et al. Rehabilitation After Oswestry Autologous-Chondrocyte Implantation: The OsCell Protocol. J Sport Rehabil 2003; 12: 104-118
21 Flanigan DC, Sherman SL, Chilelli B. et al. Consensus on Rehabilitation Guidelines among Orthopedic Surgeons in the United States following Use of Third-Generation Articular Cartilage Repair (MACI) for Treatment of Knee Cartilage Lesions. Cartilage 2021; 13: 1782S-1790S
22 Ebert JR, Robertson WB, Lloyd DG. et al. Traditional vs accelerated approaches to post-operative rehabilitation following matrix-induced autologous chondrocyte implantation (MACI): comparison of clinical, biomechanical and radiographic outcomes. Osteoarthritis Cartilage 2008; 16: 1131-1140
23 Rogan S, Taeymans J, Hirschmüller A. et al. [Effect of continuous passive motion for cartilage regenerative surgery – a systematic literature review]. Z Orthop Unfall 2013; 151: 468-474
24 Marder RA, Hopkins jr G, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy 2005; 21: 152-158
25 Minas T, Gomoll AH, Solhpour S. et al. Autologous chondrocyte implantation for joint preservation in patients with early osteoarthritis. Clin Orthop Relat Res 2010; 468: 147-157
26 Smidt GL. Biomechanical analysis of knee flexion and extension. J Biomech 1973; 6: 79-92
27 Kulas AS, Hortobagyi T, DeVita P. Trunk position modulates anterior cruciate ligament forces and strains during a single-leg squat. Clin Biomech (Bristol, Avon) 2012; 27: 16-21
28 Schmitt LC, Quatman CE, Paterno MV. et al. Functional outcomes after surgical management of articular cartilage lesions in the knee: a systematic literature review to guide postoperative rehabilitation. J Orthop Sports Phys Ther 2014; 44: 565-578
29 Buckthorpe M, La Rosa G, Villa FD. Restoring Knee Extensor Strength after Anterior Cruciate Ligament Reconstruction: A Clinical Commentary. Int J Sports Phys Ther 2019; 14: 159-172
30 Stien N, Saeterbakken AH, Andersen V. Electromyographic Comparison of Five Lower-Limb Muscles between Single- and Multi-Joint Exercises among Trained Men. J Sports Sci Med 2021; 20: 56-61
31 Bennell KL, Dobson F, Roos EM. et al. Influence of Biomechanical Characteristics on Pain and Function Outcomes From Exercise in Medial Knee Osteoarthritis and Varus Malalignment: Exploratory Analyses From a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2015; 67: 1281-1288
32 Hirschmüller A, Andres T, Schoch W. et al. Quadriceps Strength in Patients With Isolated Cartilage Defects of the Knee: Results of Isokinetic Strength Measurements and Their Correlation With Clinical and Functional Results. Orthop J Sports Med 2017; 5: 2325967117703726
33 Mosler AB, Kemp J, King M. et al. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. Br J Sports Med 2020; 54: 702-710
34 Kierkegaard S, Mechlenburg I, Lund B. et al. Is hip muscle strength normalised in patients with femoroacetabular impingement syndrome one year after surgery?: Results from the HAFAI cohort. J Sci Med Sport 2019; 22: 413-419
35 Pietrosimone B, Lepley AS, Harkey MS. et al. Quadriceps Strength Predicts Self-reported Function Post-ACL Reconstruction. Med Sci Sports Exerc 2016; 48: 1671-1677
36 Pietrosimone B, Pfeiffer SJ, Harkey MS. et al. Quadriceps weakness associates with greater T1rho relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27: 2632-2642
37 Nawasreh Z, Logerstedt D, Cummer K. et al. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med 2018; 52: 375
38 Lepley AS, Lepley LK. Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil 2022; 31: 707-716
39 Rice DA, McNair PJ, Lewis GN. et al. Quadriceps arthrogenic muscle inhibition: the effects of experimental knee joint effusion on motor cortex excitability. Arthritis Res Ther 2014; 16: 502
40 Hart JM, Pietrosimone B, Hertel J. et al. Quadriceps activation following knee injuries: a systematic review. J Athl Train 2010; 45: 87-97
41 Norte G, Rush J, Sherman D. Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. J Sport Rehabil 2022; 31: 717-735
42 Logerstedt DS, Scalzitti DA, Bennell KL. et al. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. J Orthop Sports Phys Ther 2018; 48: A1-A50
43 Hasegawa S, Kobayashi M, Arai R. et al. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2011; 21: 622-630
44 Spector P, Laufer Y, Elboim Gabyzon M. et al. Neuromuscular Electrical Stimulation Therapy to Restore Quadriceps Muscle Function in Patients After Orthopaedic Surgery: A Novel Structured Approach. J Bone Joint Surg Am 2016; 98: 2017-2024
45 Edwards PK, Ackland T, Ebert JR. Clinical rehabilitation guidelines for matrix-induced autologous chondrocyte implantation on the tibiofemoral joint. J Orthop Sports Phys Ther 2014; 44: 102-119
46 Edwards PK, Ackland TR, Ebert JR. Accelerated weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation in the tibiofemoral joint: early clinical and radiological outcomes. Am J Sports Med 2013; 41: 2314-2324
47 Hirschmüller A, Baur H, Braun S. et al. Rehabilitation after autologous chondrocyte implantation for isolated cartilage defects of the knee. Am J Sports Med 2011; 39: 2686-2696
48 Skelley NW, Kurtenbach C, Kimber K. et al. Return-to-Sport Review for Current Cartilage Treatments. J Knee Surg 2021; 34: 39-46
49 Krych AJ, Pareek A, King AH. et al. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25: 3186-3196
50 Hurley ET, Davey MS, Jamal MS. et al. Return-to-Play and Rehabilitation Protocols following Cartilage Restoration Procedures of the Knee: A Systematic Review. Cartilage 2021; 13: 907S-914S
51 Campbell AB, Pineda M, Harris JD. et al. Return to Sport After Articular Cartilage Repair in Athletes’ Knees: A Systematic Review. Arthroscopy 2016; 32: 651-668.e1
52 Davies GJ, McCarty E, Provencher M. et al. ACL Return to Sport Guidelines and Criteria. Curr Rev Musculoskelet Med 2017; 10: 307-314
53 Trattnig S, Winalski CS, Marlovits S. et al. Magnetic Resonance Imaging of Cartilage Repair: A Review. Cartilage 2011; 2: 5-26
54 Mithoefer K, Hambly K, Logerstedt D. et al. Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete. J Orthop Sports Phys Ther 2012; 42: 254-273
55 Protokollempfehlungen der AG Bildgebende Verfahren des Bewegungsapparates (AG BVB) der Deutschen Röntgengesellschaft (DRG) zu Messsequenzen für die Gelenk-MRT. Rofo [Anonym]. 2018; 190: 186-190