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 guidelines. There are few randomised controlled trials for rehabilitation whereas there are several trials for surgical techniques.
Guidelines for indications for specific surgical techniques are based according to the type of lesion to be treated. Factors for the lesion characterisation including symptoms, size and location of the lesion combined with the sporting aspirations of the patient and their compliance. In the same manor that surgery is tailored to the lesion then rehabilitation needs to be tailored to suit the patient.
The result is that rehabilitation for cartilage repair becomes tailored to the aims of surgery and to the patient’s expectations in addition to the nature of the lesion. The main goal for cartilage surgery is to reduce swelling and to reduce pain in combination with improvement of function, activities of daily living and sport activities. Rehabilitation is directed to those aims.
Rehabilitation includes different phases: pre-operative, post-operative rehabilitation and also consideration for non-operative rehabilitation programmes. Not everyone needs surgery.
Optimal rehabilitation depends on an understanding of combination of factors including the basic science evidence for rehabilitation, biomechanics of the knee joint as it applies to cartilage loading and practical research studies for rehabilitation programmes.