Below is a consolidation of personal e-mails and KneeGuru posts that were made during my rehab after reconstruction of my patellar tendon by Dr. Noyes. I was suffering from severe arthrofibrosis and severe patella baja with a very short patellar tendon. Prior to the surgery I was in severe, constant pain and limited flexion (105 degrees with overpressure and 80 to 90 actively). I thought it would be beneficial to compile them all in one place so that others who are battling a painful rehabilitation can share my ups, downs, frustration, and ultimate success.

Focht BC. Effectiveness of exercise interventions in reducing pain symptoms among older adults with knee osteoarthritis: A review. Journal of Aging and Physical Therapy. 2006;14:212--235.

This author has reviewed the literature up to 2006 to see if there is any consensus about the value of exercise in older people with knee osteoarthritis (OA).

Interpretation of journal article -

Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T and Lane, KA. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis and Rheumatism (Arthritis Care and Research). 2006;55(5):690-699.

Interpretation of journal article:

Deyle, GD, Allison SC, Matekel RL, Ryder MG, Stang M, Gohdes DD, Hutton JP, Henderson NE, Garber MB. Physical therapy treatment effectiveness for osteoarthritis of a knee: A randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical Therapy. 2005;12:1301-1317.

The medical literature is largely accessible to patients. The language is hard to read, the articles are stored in libraries and it is also hard for readers to put the information into the context of the time in which is was published. We try to overcome these issues by interpreting some of the literature for our readers and also trying to put it into context. Key articles on exercise for arthritis, in date order of publication, that we have reviewed/interpreted for you include -

In the 'in-depth review' section of the KNEEguru website there is a desk-based study on this topic researched by Karen Hambly - see Cycling for Knee Rehabilitation - note that this will open the article in a new window - to return to this page, just close that new window.

• Saddle height
• How to set up the saddle height
• Backward pedalling on a stationary bike
• Recumbent cycling
• Getting back on the road
• References and links

I am constantly amazed by some of the experiences that people tell me they go through when they go to see their physio after they have had articular cartilage repair. A couple of classics that I come across way too frequently are -

When I told my physio that I had ACI surgery they said "so you've had your ligament repaired! or 

When I went to the physio they had never heard of microfracture/OATS/Mosaicplasty/ACI (delete as appropriate!) and they had no details of my operation from the surgeon.

Millett PJ, Johnson B, Carlson J, Krishan S and Steadman JR. Rehabilitation of the arthrofibrotic knee. Am J Orth. 2003;11:531-538.

This is a review article discussing the significance of prevention and early recognition of arthrofibrosis. The authors note that arthrofibrosis of the knee can be localised or global, and can restrict flexion or extension of the knee or movement of the patellofemoral joint.

It wasn't until I found myself in the position of being a prospective patient for articular cartilage repair that I decided to do a bit of reading around the area. Now you may think that as I am a fully qualified chartered physiotherapist that I should have known all about articular cartilage problems and how they are managed. The reality of things is that the only time in the whole of my physio training that articular cartilage was ever mentioned was in relation to osteoarthritis.