Weight-bearing and Knee Orthoses Protocols Following Tibiofemoral Articular Cartilage Surgery: Developing an Expert Recommendation

Lauren Gavrailoff

Purpose: Post-operative protocols for tibiofemoral articular cartilage procedures need to balance safe, progressive joint loading while avoiding graft failure. The purpose of this study was to develop an expert recommendation to meet this balance.

Methods: A mixed-methods approach combined in-depth literature review, survey research, face-to-face focus groups, and Delphi rounds to establish expert recommendations from North American Orthopaedic Surgeons.

Findings: Ten North American Orthopaedic Surgeons developed expert recommendations and two post-operative protocols. Weight-bearing timelines were dependent on surgical procedure type, while bracing was considered after cell-based and structural procedures during an individual’s transition from partial to full weight-bearing. Further clinical evidence is needed to quantify the amount of joint loading or unloading that optimizes cartilage healing for injuries or post-surgical sites.

Conclusion: These protocols can be used as expert recommendations to guide clinical practice, and should be individualized on a per patient bases for the most favorable patient outcomes.