International Cartilage Repair Society edition:9the World Congress location:Sitges Barcelona, Spain date:September 2010
Purpose: Rehabilitation following cartilage repair procedures and compliance to rehabilitation are often stated as important, but rarely studied. The major aim of the study was to explore the effect of patient compliance on the objective functional outcome up to 2 years after surgery. Therefore an identical rehabilitation program was implemented and followed-up in the RCT comparing characterized chondrocyte implantation (CCI) versus microfracture (MF).
Methods and Materials: In a cohort design patient compliance to an identical rehabilitation protocol was studied. An electronic report form including 18 physiotherapy variables was used to compare physiotherapy management. Patients’ objective functional outcome was assessed using the pooled symmetry index (SI)based on one strength and 3 hop tests. The objective outcomes were evaluated pre-surgery, at 1 and 2 years post-surgery.
Results: During the first 3 months 85% of the physiotherapists reported weekly. Overall physiotherapists adhered very consistently and showed comparable management to the protocol in both treatment groups. In contrast in both treatment groups patients showed great variability in the amount of time (minutes per day) they were active in low load activities. Two cohorts were created. Patients with good compliance to the rehabilitation protocol (Good Comp, n=21) and patients with poor compliance (Poor Comp, n=17) performed activities in low load conditions for a mean of 45 minutes a day and 7 minutes a day respectively. These cohorts were not significantly different for any other parameter. At 24 months after surgery the Good Comp cohort performed the objective functional tests significantly better compared to the Poor Comp cohort. The mean pooled SI of the Good Comp cohort was 92.4% compared to 78.2% for the Poor Comp cohort (95%CI 1.8 to 26.2).
Conclusions: High patient compliance to the rehabilitation protocol,which reflects a high amount of low load activities post-surgery, appears beneficial for the objective functional outcome at 24 months after surgery.