Functional outcomes after surgical management of articular cartilage lesions in the knee: A systematic literature review to guide postoperative rehabilitation

Laura C. Schmitt, Carmen E. Quatman, Mark V. Paterno, Thomas Best, David C. Flanigan

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

STUDY DESIGN: Systematic literature review. TTOBJECTIVE: To systematically review the literature relative to muscle performance, knee joint biomechanics, and performance-based functional outcomes following articular cartilage repair and restoration surgical procedures in the knee. TTBACKGROUND: Articular cartilage injuries are associated with functional limitations, poor quality of life, and the potential for long-term disability. This review systematically evaluates evidence related to muscle performance, joint biomechanics, and performance-based functional outcomes following articular cartilage procedures, and discusses their implications for rehabilitation. TTMETHODS: The online databases of PubMed (MEDLINE), CINAHL, SPORTDiscus, and Scopus were searched (inception to September 2013). Studies pertaining to muscle performance, knee joint biomechanics, and performance-based measures of function following articular cartilage procedure in the knee were included. TTRESULTS: Sixteen articles met the specified inclusion criteria. Seven studies evaluated muscle performance, all showing persistent deficits in quadriceps femoris muscle strength for up to 7 years postprocedure. Quadriceps femoris strength deficits of greater than 20% were noted in 33% and 26% of individuals at 1 and 2 years following microfracture and autologous chondrocyte implantation (ACI), respectively. Two studies evaluated knee mechanics post-ACI, showing persistent deficits in knee kinematics and kinetics for up to 12 months postprocedure compared to uninjured individuals. Seven studies showed improved functional capacity (6-minute walk test) over time, and 3 studies showed persistent performance deficits during higher-level activities (single-leg hop test) for up to 6 years postprocedure. Five studies comparing weight-bearing protocols (accelerated versus traditional/current practice) following ACI found few differences between the groups in function and gait mechanics; however, persistent gait alterations were observed in both groups compared to uninjured individuals. TTCONCLUSION: Significant quadriceps femoris strength deficits, gait deviations, and functional deficits persist for 5 to 7 years following ACI and microfracture surgical procedures. Future research regarding rehabilitation interventions to help mitigate these deficits is warranted.

Original languageEnglish (US)
Pages (from-to)565-578
Number of pages14
JournalJournal of Orthopaedic and Sports Physical Therapy
Volume44
Issue number8
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Quadriceps Muscle
Articular Cartilage
Chondrocytes
Biomechanical Phenomena
Knee
Rehabilitation
Gait
Muscles
Stress Fractures
Knee Joint
Mechanics
Humulus
Weight-Bearing
Muscle Strength
PubMed
MEDLINE
Leg
Joints
Quality of Life
Databases

Keywords

  • Gait
  • Microfracture
  • Strength
  • Sutologous chondrocyte implantation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Functional outcomes after surgical management of articular cartilage lesions in the knee : A systematic literature review to guide postoperative rehabilitation. / Schmitt, Laura C.; Quatman, Carmen E.; Paterno, Mark V.; Best, Thomas; Flanigan, David C.

In: Journal of Orthopaedic and Sports Physical Therapy, Vol. 44, No. 8, 01.01.2014, p. 565-578.

Research output: Contribution to journalReview article

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abstract = "STUDY DESIGN: Systematic literature review. TTOBJECTIVE: To systematically review the literature relative to muscle performance, knee joint biomechanics, and performance-based functional outcomes following articular cartilage repair and restoration surgical procedures in the knee. TTBACKGROUND: Articular cartilage injuries are associated with functional limitations, poor quality of life, and the potential for long-term disability. This review systematically evaluates evidence related to muscle performance, joint biomechanics, and performance-based functional outcomes following articular cartilage procedures, and discusses their implications for rehabilitation. TTMETHODS: The online databases of PubMed (MEDLINE), CINAHL, SPORTDiscus, and Scopus were searched (inception to September 2013). Studies pertaining to muscle performance, knee joint biomechanics, and performance-based measures of function following articular cartilage procedure in the knee were included. TTRESULTS: Sixteen articles met the specified inclusion criteria. Seven studies evaluated muscle performance, all showing persistent deficits in quadriceps femoris muscle strength for up to 7 years postprocedure. Quadriceps femoris strength deficits of greater than 20{\%} were noted in 33{\%} and 26{\%} of individuals at 1 and 2 years following microfracture and autologous chondrocyte implantation (ACI), respectively. Two studies evaluated knee mechanics post-ACI, showing persistent deficits in knee kinematics and kinetics for up to 12 months postprocedure compared to uninjured individuals. Seven studies showed improved functional capacity (6-minute walk test) over time, and 3 studies showed persistent performance deficits during higher-level activities (single-leg hop test) for up to 6 years postprocedure. Five studies comparing weight-bearing protocols (accelerated versus traditional/current practice) following ACI found few differences between the groups in function and gait mechanics; however, persistent gait alterations were observed in both groups compared to uninjured individuals. TTCONCLUSION: Significant quadriceps femoris strength deficits, gait deviations, and functional deficits persist for 5 to 7 years following ACI and microfracture surgical procedures. Future research regarding rehabilitation interventions to help mitigate these deficits is warranted.",
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