Purpose To present our experience with an interesting case of bilateral consecutive matrix autologous chondrocyte implantation (MACI) in the knees of an Olympic level skier. The rehabilitation protocol applied had a few but significant differences compared to other protocols, regarding the rate and methods of increasing joint loading during the early phases of rehabilitation.
Methods and materials A 29-year-old, alpine skier with bilateral chondral lesions of the trochleas and the left lateral femoral condyle. Preoperative International Knee Documentation Committee subjective score was 58(L) and 62 (R). In October 2007, he underwent bilateral knee arthroscopic evaluation and cartilage biopsy. In November 2007 the first MACI was conducted in his left knee, and the second MACI in the right knee in March 2008. A second look arthroscopy took place in the left knee. The rehabilitation protocol followed the guidelines outlined by Hambly et al (2006) with a few modifications:
– Non-weight bearing
(left knee): 4 weeks (right knee): 1 week
– Full weight bearing
(left knee): 6 weeks (right knee): 4 weeks
– Closed kinetic chain exercise (rowing-free handed)
(left knee): 6 weeks (right knee): 6 weeks
– Intermmitent compression of repair site with use of dynamometer Controlled isometric contractions in angles that engaged the repaired sites. The applied load was controlled via optical biofeedback from dynamometer.
(left knee): 8 weeks (right knee): 10 weeks
Results The athlete was able to returned to acceptable performance levels on the exercise physiology lab at 8 months. He was able to participate in high level races by 12 months. His 12 month IKDC score reached 94 (L) and 88 (R).
Conclusions Accelerated rehabilitation with the inclusion of controlled intermmitent compression of the repair sites early in the rehabilitation process is safe and may promote tissue regeneration at a faster rate than previously thought.
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