Physical therapy and rehabilitation in chondral lesions

Although most patients with articular cartilage defects are asymptomatic, some may have symptoms such as pain, effusion, muscle weakness, and limited range of motion. The goals of rehabilitation in chondral lesions are to relieve clinical symptoms, obtain painless full range of motion and muscle strength, and improve function. The key point in the rehabilitation program is to improve sensorimotor function and decrease pain and disability without increasing cartilage degeneration. Basic principles in the postoperative rehabilitation period are the same as those in conservative treatment. However, the rehabilitation program should be modified depending on the surgical procedure. Each phase of the rehabilitation program should be designed considering the type of surgical procedure, estimated healing time, restoration of joint mobility and muscle strength, and the extent of pain and effusion. Exposing the healing cartilage to shear stress under compression may have adverse effects on the healing process. For this reason, the early stage of rehabilitation (0-6 weeks) is comprised of passive, active-assistive and non-weight bearing range of motion exercises. Postoperative weight-bearing depends on the size, nature, and location of the lesion and the surgical procedure. Restriction in weight bearing is recommended in all treatment procedures except for cartilage debridement. For a successful outcome, open communication should exist between the rehabilitation team and the surgeon and the rehabilitation program should be individualized.