Hirschmüller Anja, Schoch Wolfgang, Baur Heiner, Wondrasch Barbara, Konstantinidis Lukas, Südkamp Nobert P, Niemeyer Philipp
Department of Orthopedics and Trauma Surgery, Albert-Ludwigs University of Freiburg, Medical Center, Freiburg, Germany.
Altius Swiss Sportmed Center AG, Rheinfelden, Switzerland.
Arch Orthop Trauma Surg. 2019 Feb;139(2):217-230. doi: 10.1007/s00402-018-3026-6. Epub 2018 Aug 21.
Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field. The preoperative time frame may be used to start rehabilitation which may fasten the postoperative recovery and optimize clinical outcome ("Prehabilitation"-PREHAB). The aim of this article, therefore, was to review the available literature on prehabilitation concepts and to present a prehabilitation guideline for CRS patients based on the best evidence available.
A systemic literature research was conducted on rehabilitation for cartilage regenerative surgery as well as prehabilitation in knee joint procedures. From the available literature a prehabilitation concept was generated and tested in 10 ACI patients.
As the literature search found no studies addressing prehabilitation in CRS patients, an evidence-based PREHAB program has been compiled based on the available evidence from (a) studies addressing postoperative rehabilitation in CRS patients and (b) PREHAB studies on other knee procedures including TKA. This presented prehabilitation guideline has been tested in > 50 CRS patients and was found to be feasible as all of the patients showed a good compliance and were able to perform the protocol as suggested.
The presented PREHAB regimen may serve clinicians as a guideline for early rehabilitation of their CRS patients. Obviously, further research is mandatory to quantify its clinical effect and to demonstrate its cost-effectiveness and benefits in surgically treated patients.
局灶性软骨缺损是一个日益突出的临床问题，在运动员中尤为常见。在过去二十年中，包括微骨折和自体软骨细胞移植（ACI）在内的软骨再生手术（CRS）已被广泛应用于治疗膝关节孤立性软骨缺损。尽管在手术技术、细胞相关问题和临床结果方面有大量高级别证据，但关于最佳康复过程的知识仍然匮乏，尽管优化康复过程的重要性最近已成为该领域新的研究重点。术前阶段可用于开始康复，这可能会加快术后恢复并优化临床结果（“术前康复” - PREHAB）。因此，本文旨在回顾关于术前康复概念的现有文献，并根据现有最佳证据为CRS患者提供术前康复指南。
对软骨再生手术的康复以及膝关节手术中的术前康复进行了系统的文献研究。从现有文献中生成了一个术前康复概念，并在10名ACI患者中进行了测试。
由于文献检索未发现关于CRS患者术前康复的研究，因此基于以下两方面的现有证据编制了一个基于证据的PREHAB计划：（a）关于CRS患者术后康复的研究，以及（b）关于包括全膝关节置换术（TKA）在内的其他膝关节手术的术前康复研究。这个提出的术前康复指南已在50多名CRS患者中进行了测试，发现是可行的，因为所有患者都表现出良好的依从性，并且能够按照建议执行方案。
所提出的PREHAB方案可为临床医生作为其CRS患者早期康复的指南。显然，需要进一步研究以量化其临床效果，并证明其在手术治疗患者中的成本效益和益处。
