ABSTRACT FORM XXIII International Conference of Sport Rehabilitation and Traumatology Milano Italy ‐ March 22 nd – 23 rd 2014 TITLE TITOLO Rehabilitation principles for cartilage regeneration AUTHORS AUTORI Hambly K (UK) SESSION SESSIONE Chondral and osteochondral defects: surgery and return to sport DATE AND TIME DATA E ORA SATURDAY 22ND MARCH, 2014 – 15:30 TEXT ‐ TESTO (4500 characters maximum spaces included– massimo 4500 caratteri spazi inclusi) Cartilage rehabilitation presents many challenges for clinicians, therapists and patients. The core principles underpinning cartilage rehabilitation are those at the foundation of all musculoskeletal rehabilitation encompassing anatomy, biomechanics, assessment, therapeutic exercise, treatment modalities and outcome evaluation. 1 To effectively apply these principles to cartilage rehabilitation a working knowledge and understanding of the response of articular cartilage to injury and surgery is essential. Historically, cartilage rehabilitation guidelines have been time criterion based and as the durability and resilience of repair tissue was not fully established they inclined to be conservative. 2 The focus on the rehabilitation tended to be heavily weighted towards the protection of the repair tissue, often, it could be argued at the expense of other aspects critical to function and optimal long-term recovery. In the last decade there has been a drive for a change of culture and a shift of emphasis from time criterion to functional criterion in cartilage rehabilitation necessitating greater individualisation. Clinical evidence is needed to inform the optimisation of the rehabilitation for an individual and to facilitate this move from time to functional criterion. This is especially important for the sportsperson. Noteworthy research has now been conducted in several key areas that can be used to inform the rehabilitation process following cartilage repair procedures. The area where the most research has been conducted in recent years is the progression and return to full weight-bearing (FWB). 3,4 There remains insufficient clinical evidence to optimise the use of therapeutic modalities in areas such as continuous passive motion 5,6 and post-operative bracing. 7,8 One of the greatest challenges in cartilage repair rehabilitation is the restoration of muscle strength 9 as research has highlighted that, despite, comprehensive rehabilitation, long-term post-operative deficits in muscle strength are evident. 10,11 Finally, there is opportunity to improve the quality of rehabilitation reporting in published cartilage repair studies. 12 References 1 Mithoefer K, Hambly K et al. Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete. J Orthop Sports Phys Ther. 2012; 42: 254-73. 2 Hambly K, Bobic V et al. Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. Am J Sports Med. 2006; 34: 1020-38. 3 Wondrasch B, Zak L et al. Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle on radiographic and clinical outcome after 2 years: a prospective, randomized controlled pilot study. Am J Sports Med. 2009; 37: 88S-96S. 4 Ebert J & Edwards P. The evolution of progressive, post-operative weight bearing following autologous chondrocyte implantation in the tibiofemoral joint. J Sports Rehabil. 2013. Dec 4 Epub. 5 Fazalare J, Griesser M et al. The use of continuous passive motion following knee cartilage defect surgery: a systematic review. Orthopedics. 2010; 33: 878. 6 Karnes J, Harris J et al. Continuous passive motion following cartilage surgery: does a common protocol exist? Phys Sportsmed. 2013; 41: 53-63. 7 Ebert J, Hambly K et al. Does an unloader brace reduce knee loading in normally aligned knees? Clin Orthop Relat Res. 2013. Sep 25 Epub. 8 Orishimo K, Kremenic I et al. Is valgus unloader bracing effective in normally aligned individuals: implications for post- surfical protocols following cartilage restoration procedures. Knee Surg Sports Traumatol Arthrosc. 2013; 21: 2661-6. 9 Hambly K, Silvers H et al. Rehabilitation after articular cartilage repair of the knee in the football (soccer) player. Cartilage. 2012; 3: 50S-6S. 10 Loken S, Ludvigsen T et al. Autologous chondrocyte implantation to repair knee cartilage injury: ultrastructural evaluation