Controlling sheer stress and load is more complex in the patello femoral joint. The surgeon needs to specify the contact position of the articular cartilage so that exercises can be undertaken outside of this particular movement. The principle here is that when the area of repair is on the distal part of the patella or…
Rehabilitation depends on three determining factors: Location of repaired defect, Size of lesion and state of the border (contained or not). Controlling sheer stress and loading in the tibia femoral joint is undertaken by a variety of methods: Understanding of exact location of the repair and how it impinges on the opposing side and at…
Rehabilitation can be individualised according to the following factors. General factors: Age Motivation Social support Specific local factors: Exact location of repair Size of repair Condition of the borders of the repair (contained or not contained) Duration of symptoms before surgery (more less than twelve months) Pre-injury activity level (professional or nonprofessional, high or low…
3.7.1 Nutrition and Joint Circulation Exercises In order to maintain nutrition of the articular cartilage the synovial fluid needs to circulate around the knee, remembering that cells source their nutrition from the joint fluid, not the bone marrow base. This is aided by joint circulation exercises, stimulating synovial fluid production and nutrition of articular cartilage….
Articular Cartilage Rehabilitation Rehabilitation needs to take into account the underlying biological healing process of the new articular cartilage combined with the concept of protecting the repaired tissue while simultaneously trying to first maintain, and then improve, general function. The main phases are as follows: 1. Preoperative phase: Reduction of joint inflammation. Optimising the knee…
Rehabilitation of Patients after Cartilage Repair Procedures Detailed scientific basis for rehabilitation is lacking and this has been criticised in various review papers. In addition to evaluating techniques, compliance with rehabilitation regimes is also difficult to assess. Most surgeons and therapists however realise the importance of rehabilitation in the contribution to the overall outcome. Another…
Neuromuscular Control and Muscle Strength The function of good quality muscles and muscle strength is to act as a shock absorber to the load bearing and reduce peak impact forces. Muscle strength in combination with endurance and flexibility is therefore important to help dissipate the forces over the knee joint. Sometimes after injury the quadriceps…
Joint Loading and Biomechanics Loading of a joint can have variable effects on the articular cartilage. Sudden impact loading can cause specific damage and in addition repetitive loading may also promote degenerative change whereas appropriate load within the required range will help with nutrition and function of the joint. The articular cartilage acts as a…
Basic Science and Articular Cartilage Healing Articular cartilage has no blood supply and no nerve supply. Chondrocytes (articular cartilage cells) obtain their nutrition from the synovial fluid while the underlying bone provides nutrition to the deeper layers. Chondrocytes function to produce the extracellular matrix and work hard to produce proteoglycans. Collagen fibres turn over less…
Evidence base for Rehabilitation Techniques for cartilage repair have been developed over the last 15 to 20 years but unfortunately there is no detailed scientific basis for rehabilitation programmes. Most of what is followed at the moment is based on a combination of basic science work combined with expert opinions and published techniques with rehabilitation…
