ABSTRACT: Variability of United States Online Rehabilitation Protocols for Osteochondral Allograft Transplant Surgeries
BACKGROUND CONTEXT: OSTEOCHONDRAL ALLOGRAFT TRANSPLANT (OATs)
Chondral lesions of the knee, particularly in weight bearing portions, can affect the young and active population, thus leading to severe morbidity and daily challenges. Osteochondral Allograft Transplantation (OAT) is a common treatment for articular cartilage defects in weight bearing portions of the knee. Because this is a new procedure rehabilitation protocols and its various parameters that are given to patients vary greatly.
Purpose: The purpose of this project was to assess the variability across OATs protocols provided for patients online by physician personal websites and/or surgical center websites.
Study Design: Cross-sectional study
Methods: Online OAT therapy protocols were found through a web-based search using the search term “osteochondral allograft transplant rehabilitation protocols” yielding a total of 38 OAT protocols. A comprehensive scoring rubric was generated after review of the 38 protocols and was used to evaluate each protocol for the presence of different rehabilitation components and the point at which those components were introduced and/or discontinued.
Results: Of the 38 rehabilitation protocols identified twenty-seven protocols (71%) recommended immediate non-weight bearing status, 11 (29%) recommended immediate partial weight bearing status. Thirty-six (94%) of the protocols reviewed reported a return to full weight bearing status at a mean of 8.0 weeks (range of 4-12 weeks),35 (92%) prescribed knee bracing, 15 (39%) did not specify knee brace timeline and/or instructional use, and 20 (52%) specified immediate knee bracing weeks 0-6 with opening instructions. Of the 35 protocols that listed brace use 32 (84%) of total protocols gave specific brace discontinuation timelines with a mean of 6.0 weeks (range: 2 to 8 weeks). Out of 38 protocols 19 (50%) mentioned the use of crutches, of which only 13 of those correlated crutch-use with initiation timelines with a mean of 1.3 weeks (range: weeks 0 – 8); 6 (15%) out of 38 protocols listed discontinuation of crutches with a mean of 4.1 weeks (range: 6-12 weeks). In regards to allowing immediate initiation of knee range of motion 24 (63%) protocols specified starting post-op ROM with a mean of 1.8 weeks (range: weeks 0 to 8). In regards to Continuous Passive Motion (CPM) machine use 30 (79%) of protocols recommended immediate use within a range of weeks 0 through 6. When documenting a patient’s advancement into full ROM 22 (58%) of total protocols had the transition begin at a mean of 4.3 weeks (range: 4 - 24 weeks). 29 (76%) of protocols documented a patient’s return to athletic activity at a mean of 7.4 months (range 3-24 months), 21 (55%) of protocols listed a patient’s return to basic activity with a start time averaging 5.1 months (range: 2 - 24 months). Initiation of closed chain exercises were documented by 30 (79%) protocols within a range of 2 to 16 weeks with a mean of 7.1 weeks. Considerable variability was noted in the inclusion and timing of strengthening exercises with the following exercises being utilized the most out of the 38 reviewed protocols: stationary bike 35 (92%), straight leg raises 35 (92%), quad sets 32 (84%), mini squats 31 (81%), and patellar mobilizations 30 (79%).
Conclusion: Evident variability is found in both the composition and timing of rehabilitation protocol components through the multiple osteochondral allograft transplant rehabilitation protocols published online. This conclusion highlights the variability of recommended rehabilitation protocols in professional literature and signifies an opportunity to improve patient care.