Subscribe to RSS
DOI: 10.1055/s-2006-942224
© Georg Thieme Verlag Stuttgart · New York
Rehabilitation after MACT in the Knee: Presentation of Two Rehabilitation Protocols after MACT According to Defect Localisation Based on the Biomechanics of the Knee, the Physiology of Cartilage and the Healing Process of the Graft
Publication History
Publication Date:
02 November 2006 (online)
Abstract
Matrix-associated chondrocyte transplantation (MACT), an advancement of the classical autologous chondrocyte transplantation (ACT), is a tissue engineering technique for the treatment of full thickness articular defects and requires the use of a cell-scaffold construct which is implanted in the debrided cartilage defect. To achieve both good objective and subjective results and to maximise the benefits of MACT, patients have to adhere to an MACT-specific rehabilitation programme. The aims of the rehabilitation after MACT are to ensure an optimal graft healing by local adaptation and remodelling of the repair and to return the patient to an optimal level of function. It is a challenge to optimise the achievement of these two controversial goals - graft protection and return to function - within rehabilitation. The three main components of the individualised and progressive, yet safe, rehabilitation programme are: progressive weight bearing, restoration of range of motion (ROM) and enhancement of muscle control and strengthening. The modalities of the three main components, that are progressive weight bearing, restoration of ROM and enhancement of muscle control and strengthening, are based on the physiology of cartilage, the biomechanics of the knee and the biology of the graft.
Key words
cartilage defect - matrix-associated autologous chondrocyte transplantation - knee joint - rehabilitation
References
- 1 Bailey A. Rehabilitation after Oswestry autologous-chondrocyte implantation: The Oscell protocol. J Sports Rehabil. 2003; 12 104-118
- 2 Besier T F, Draper C E, Gold G E, Beaupre G S, Delp S L. Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res. 2005; 23 345-350
- 3 Bowen T R, Feldmann D D, Miller M D. Return to play following surgical treatment of meniscal and chondral injuries to the knee. Clin Sports Med. 2004; 23 381-393 , viii-ix
- 4 Brittberg M, Peterson L, Sjogren-Jansson E, Tallheden T, Lindahl A. Articular cartilage engineering with autologous chondrocyte transplantation. A review of recent developments. J Bone Joint Surg [Am]. 2003; 85 (Suppl 3) 109-115
- 5 Buckwalter J A. Effects of early motion on healing of musculoskeletal tissues. Hand Clin. 1996; 12 13-24
- 6 Clark A L, Herzog W, Leonard T R. Contact area and pressure distribution in the feline patellofemoral joint under physiologically meaningful loading conditions. J Biomech. 2002; 35 53-60
- 7 Cohen N P, Foster R J, Mow V C. Composition and dynamics of articular cartilage: structure, function, and maintaining healthy state. J Orthop Sports Phys Ther. 1998; 28 203-215
- 8 Desio S M, Burks R T, Bachus K N. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med. 1998; 26 59-65
- 9 Escamilla R F. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001; 33 127-141
- 10 Gillogly S D. Treatment of large full-thickness chondral defects of the knee with autologous chondrocyte implantation. Arthroscopy. 2003; 19 (Suppl 1) 147-153
- 11 Gillogly S D, Voight M, Blackburn T. Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther. 1998; 28 241-251
- 12 Grelsamer R P, Klein J R. The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther. 1998; 28 286-298
- 13 Brechter J H, Powers C M, Terk M R, Ward S R, Lee T Q. Quantification of patellofemoral joint contact area using magnetic resonance imaging. Magn Reson Imaging. 2003; 21 955-959
- 14 Irrgang J J, Pezzullo D. Rehabilitation following surgical procedures to address articular cartilage lesions in the knee. J Orthop Sports Phys Ther. 1998; 28 232-240
- 15 King P J, Bryant T, Minas T. Autologous chondrocyte implantation for chondral defects of the knee: indications and technique. J Knee Surg. 2002; 15 177-184
- 16 Kutscha-Lissberg F, Singer P, Vécsei V, Marlovits S. Osteochondritis dissecans of the knee joint. Radiologe. 2004; 44 783-788
- 17 Lee T Q, Morris G, Csintalan R P. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003; 33 686-693
- 18 Malone T, Davies G, Walsh W M. Muscular control of the patella. Clin Sports Med. 2002; 21 349-362
- 19 Marlovits S, Kutscha-Lissberg F, Aldrian S. et al . Autologous chondrocyte transplantation for the treatment of articular cartilage defects in the knee joint. Techniques and results. Radiologe. 2004; 44 763-772
- 20 Marlovits S, Striessnig G, Kutscha-Lissberg F. et al . Early postoperative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle. Knee Surg Sports Traumatol Arthrosc. 2005; 13 451-457
- 21 McConnell J. The physical therapist's approach to patellofemoral disorders. Clin Sports Med. 2002; 21 363-387
- 22 McGinty G, Irrgang J J, Pezzullo D. Biomechanical considerations for rehabilitation of the knee. Clin Biomech (Bristol, Avon). 2000; 15 160-166
- 23 Minas T, Peterson L. Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med. 1999; 18 13-44 , v-vi
- 24 Mont M A, Rajadhyaksha A D, Low K, LaPorte D M, Hungerford D S. Anatomy of the knee extensor mechanism: correlation with patellofemoral arthrosis. J South Orthop Assoc. 2001; 10 24-31
- 25 Nakagawa S, Kadoya Y, Kobayashi A, Tatsumi I, Nishida N, Yamano Y. Kinematics of the patella in deep flexion. Analysis with magnetic resonance imaging. J Bone Joint Surg [Am]. 2003; 85 1238-1242
- 26 O'Driscoll S W, Giori N J. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000; 37 179-188
- 27 Patel V V, Hall K, Ries M. et al . Magnetic resonance imaging of patellofemoral kinematics with weight-bearing. J Bone Joint Surg [Am]. 2003; 85 2419-2424
- 28 Patel V V, Hall K, Ries M. et al . A three-dimensional MRI analysis of knee kinematics. J Orthop Res. 2004; 22 283-292
- 29 Pedowitz R A, Gershuni D H, Crenshaw A G, Petras S L, Danzig L A, Hargens A R. Intraarticular pressure during continuous passive motion of the human knee. J Orthop Res. 1989; 7 530-537
- 30 Powers C M. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003; 33 639-646
- 31 Salem G J, Powers C M. Patellofemoral joint kinetics during squatting in collegiate women athletes. Clin Biomech (Bristol, Avon). 2001; 16 424-430
- 32 Salter R B. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res. 1989; 242 12-25
- 33 Salter R B. The physiologic basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin. 1994; 10 211-219
- 34 Salter R B. History of rest and motion and the scientific basis for early continuous passive motion. Hand Clin. 1996; 12 1-11
- 35 Salter R B, Simmonds D F, Malcolm B W, Rumble E J, MacMichael D, Clements N D. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg [Am]. 1980; 62 1232-1251
- 36 Senavongse W, Amis A A. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg [Br]. 2005; 87 577-582
- 37 Steinkamp L A, Dillingham M F, Markel M D, Hill J A, Kaufman K R. Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med. 1993; 21 438-444
- 38 Taylor W R, Heller M O, Bergmann G, Duda G N. Tibio-femoral loading during human gait and stair climbing. J Orthop Res. 2004; 22 625-632
- 39 Walker J M. Pathomechanics and classification of cartilage lesions, facilitation of repair. J Orthop Sports Phys Ther. 1998; 28 216-231
- 40 Wallace D A, Salem G J, Salinas R, Powers C M. Patellofemoral joint kinetics while squatting with and without an external load. J Orthop Sports Phys Ther. 2003; 32 141-148
B. Wondrasch
Academy of Physiotherapy · General Hospital of Vienna
Lazarettgasse 14
1090 Vienna
Austria
Phone: +43/1/4 04 00 73 02
Fax: +43/1/4 04 00 73 69
Email: barbara.wondrasch@akhwien.at