Early isometric and isotonic exercises are begun on the second postoperative day, and controlled mechanical compression is performed [25, 26]. Knee swelling is treated with ice packs that are applied over the joint for 20 min, four times per day, after rehabilitation sessions [27]. Neuromuscular electrical stimulation is allowed in addition to voluntary muscular contractions. Between 6 and 8 weeks postoperatively, gait training in a swimming pool is recommended to restore normal gait. When the patient regains full knee extension, at least 120° of knee flexion, and has normalized the gait pattern, open and closed kinetic chain strengthening exercises are encouraged, within a pain-free range of motion, together with proprioceptive exercises and aerobic training. After sufficient strength recovery is achieved, as evaluated by clinical examination with performance of a one-legged hop test 20% compared with the contralateral limb, patients begin sport-specific training through eccentric strengthening and advanced proprioceptive exercises [26]. Progression of patient rehabilitation may be adversely affected over the postoperative period by such factors as fever, joint stiffness, marked swelling, and bleeding [25–27]. In these studies about treatment of the knee, osteochondral lesions with a synthetic scaffold showed a promising clinical outcome at the short-term follow-up. The activity level was stable at 24 months, although it did not reach the pre-injury level [25–27]. Moreover, the athletic subpopulation showed a statistically significant improvement compared with the nonathletic subpopulation at the 2-year follow-up [26] (Table 47.2).

The rehabilitation protocol after biologic or hybrid surgical treatment of osteochondral injury is based on descripted by a surgeon the size and location of the osteochondral defect and the contact angle (CA). CA means the range of the joint motion when the reconstructed articular surface being in contact with the opposite surface. This is a very important information for a physiotherapist which allows the knowledge for the safe ROM designation in progression of the exercise. CA is usually useful for the joint knee osteochondral reconstruction on the contrary to the ankle joint where the CA includes full range of motion, due to high congruency of that specific joint. There is insufficient actual data in terms of rehabilitation protocol for biological osteochondral reconstructions in the knee. Because this kind of treatment is more common in the ankle joint, there are some current publications describing rehabilitation protocol for that procedure (Table 47.3).

In the authors’ experience, the individual rehabilitation strategy should be planned with taking into account four key issues as follow:

In all cases, the rehabilitation process should be modified depending on the joint status as swelling, adhesion, additional procedures or injures, as well as MRI assessment.

In the first 7–10 days, we recommend limiting joint motion, in order to encourage successful integration of the repair tissue and the formation of fibrous hematoma. After this period, range of motion exercises are begun in conjunction with joint distraction. Partial weight-bearing should begin 4 weeks after surgery, with expected unrestricted weight-bearing by week 6. It is important for the physiotherapist to be knowledgeable with respect to the goal of restoring the anatomic curvature of the articular surface, as there are designated safe ROM limitations that progress over time to address this. To optimize postoperative monitoring of the healing process and formation of repair tissue, it is recommended that patients undergo MR at 6 and 12 weeks after surgery. At 3 months, patients progress to straight-line running, with an emphasis on strength, endurance, and aerobic training. Sport-specific training typically begins at 8 months, with expected return to competition by 10 months postoperatively.