Implementation of a stadardized rehabilitation protocol in a controlled randomized multi centre study for symptomatic articular cartilage defects

OBJECTIVE: To evaluate the compliance with and the implementation of a standardized protocol for rehabilitation of patients with symptomatic joint surface defects on the femoral condyles and treated with in vivo cartilage forming cells in an ACI procedure or microfracture. METHODS: A total of 95 physiotherapists received instructions for implementing and reporting on a specific standardized rehabilitation protocol. The protocol describes the progress by goals and restrictions. Modalities to use and exercise parameters such as intensity, duration and frequency were not strictly imposed. The reporting rate was examined over a post-operative period of 3 months. The rehabilitation content was analysed for physiotherapists reporting on a weekly basis. 18 variables were defined including clinical examination, exercises, mobilisation modalities, electrotherapy and thermotherapy. RESULTS: 65 physiotherapists reported on a weekly basis. The average number of physiotherapy sessions a week was 3,1 for the microfracture group and 3,6 for the in vivo cartilage producing procedure group. For both groups the physiotherapists reported the application of 4 modalities per session. Overall the modalities used for both treatment groups were not significantly different over 12 weeks. However within specific weeks minor differences for time spent on gait reeducation, manual soft tissue mobilisation and active mobilisation exercises were observed. In general the protocol was well implemented in both groups. CONCLUSION: Overall, the standard rehabilitation protocol was implemented in a similar fashion in both treatment arms and the physiotherapists followed the protocol with an excellent compliance. This may suggest that the post operative physiotherapy is most probably not responsible for possible differences between the two cartilage repair techniques.status: publishe