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Rehab after Knee Cartilage Repair: Which Option is Best?

When the cartilage in your knee is torn clear down to the bone, it's called a full-thickness chondral defect. Surgery is the standard treatment for this type of problem. This study examines rehab programs after surgery.

Two rehab programs are compared after arthroscopic surgery to repair the cartilage. Surgery was the same for each patient. The damaged cartilage was trimmed of any loose flaps or pieces. Any nonhealing fibrous cartilage was also removed. Several holes were drilled into the bone where the cartilage attaches to stimulate healing. This procedure is called microfracture.

The first rehab program used minimal weight bearing and continuous passive motion (CPM). Patients were allowed to touch the toe to the floor when walking. CPM is a device that keeps the knee moving slowly and smoothly for hours at at time. CPM may help the cartilage and bone repair faster and better. It does this by applying moving pressure to the cartilage and bone.

The second program allowed patients to put as much weight on the foot as they could tolerate. CPM wasn't used at all in the second group. Active movement of the leg and knee was encouraged three times a day in this group.

Testing showed no difference between the two groups. Everyone was followed at least two years. Some patients were retested up to nine years later. Measures of change included reported pain, swelling, and motion. Knee function and X-rays were also used to evaluate results.

The authors conclude that the popular use of CPM after cartilage repair doesn't appear to improve patient results. They suggest using other bone grafting methods to repair cartilage in younger, athletic patients. Studies show higher success rates with bone-cartilage grafting for chondral defects.

References: Richard A. Marder, M.D., et al. Arthroscopic Microfracture of Chondral Defects of the Knee: A Comparison of Two Postoperative Treatments. In Arthroscopy. February 2005. Vol. 21. No. 2. pp. 152-158.

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