Jun 29, 2026

Level of Reporting and Clinical Reproducibily of the Rehabilitation Interventions After Surgical Treatments for Knee Cartilage Lesions: A Scoping Review.

DOI
https://dx.doi.org/10.17504/protocols.io.14egnpzzpv5d/v1
  • 1Service of Orthopaedics & Traumatology, Dept. of Surgery, EOC Lugano (Switzerland);
  • 2Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano (Switzerland)
  • EOC
Sebastiano Nutarelli
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DOI: https://dx.doi.org/10.17504/protocols.io.14egnpzzpv5d/v1
Protocol Citation: Sebastiano Nutarelli, Riccardo Stuani, Jonas Chiappini, Alessandro Sangiorgio, Giuseppe Filardo 2026. Level of Reporting and Clinical Reproducibily of the Rehabilitation Interventions After Surgical Treatments for Knee Cartilage Lesions: A Scoping Review.. protocols.io https://dx.doi.org/10.17504/protocols.io.14egnpzzpv5d/v1
License: This is an open access  protocol  distributed under the terms of the  Creative Commons Attribution License,  which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: June 24, 2026
Last Modified: June 29, 2026
Protocol  Integer ID: 319775
Keywords: surgical treatments for knee cartilage lesion, knee cartilage lesion, clinical reproducibily of the rehabilitation intervention, rehabilitation intervention, clinical reproducibily, surgical treatment, level of reporting, reporting
Abstract
TBD (the abstract will be written later, after data extraction, analysis, and manuscript completion)
Methods
Our study protocol is prepared in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR). Additionally, we drafted this article according to the 5-stage methodological framework for scoping reviews described by Arksey & O'Malley.
  1. Stage #1: Identifying the question
  2. Stage #2: Identifying the relevant literature
  3. Stage #3: Study selection and data collection processes
  4. Stage #4: Data charting
  5. Stage #5: Collating, summarizing, and reporting results
Protocol and Registration
The authors developed the protocol and made it public by registering it on protocols.io.
Research Question
Our scoping review aims to evaluate the level of reporting, hence clinical reproducibility, of post-operative rehabilitation interventions in published studies describing surgical treatments for knee cartilage lesions.

The research question is: what is the level of reporting and its clinical reproducibility of post-operative rehabilitation interventions detailed in published studies reporting the outcomes of surgical treatments for knee cartilage lesions?

The PICO elements of the title are outlined as follows:

  • Participants: “patients with knee cartilage lesionsˮ
  • Interventions: “surgical treatments for knee cartilage lesionsˮ
  • Comparators: Not applicable
  • Outcomes: “the level of reporting and its clinical reproducibility of post-operative rehabilitation interventions".
Identifying Relevant Literature
Studies will be imported from the PubMed, Cochrane, and Web of Science databases into EndNote New Jersey Institute of Technology University Heights, Newark, NJ. All duplicates will be removed with the automatic EndNote function and then through an additional blind manual check performed separately by 2 authors AS, JS, and any discrepancies between them will be resolved by discussion and consensus with a third author (SN). Then, further duplicates will be discarded, and the remaining studies will be classified as “potentially eligibleˮ. The same two authors will separately perform the selection of studies for inclusion. They will screen the titles and abstracts of the “potentially eligibleˮ studies to assess their eligibility for inclusion. Studies are considered for inclusion based on their fulfillment of the pre-specified eligibility criteria (see eligibility criteria). Full-length texts of remaining peer-reviewed articles will be sought and reviewed to determine their eligibility if there is uncertainty about their eligibility from title and abstract screening.

The eligibility criteria are detailed as follows:
  • Study design: prospective or retrospective intervention studies, case series, comparative studies, and randomized controlled trials;
  • Language: only articles published in English will be considered;
  • Publication status: full-text article published in peer-reviewed journals;
  • Sample size: at least 6 patients;
  • Clinical question (studies fulfilling the following criteria framed according to PICO studies reporting surgical treatment of knee chondral or osteochondral defects.

To be deemed eligible for inclusion, studies will be required to fulfil the following criteria (framed according to PICO):

  • Participants: “patients with knee cartilage lesionsˮ
  • Interventions: “surgical treatments for knee cartilage lesionsˮ
  • Comparators: Not applicable
  • Outcomes: “the level of reporting and its clinical reproducibility of post-operative rehabilitation interventions".
Study selection
The search strategy will be applied across three electronic databases (PubMed, Cochrane, and Web of Science). The search terms will be mapped to Medical Subject Headings MeSH) terms where possible. Search terms will be applied from conception of each database to June 2026. The reference lists of included articles will be hand searched to identify other potentially relevant articles.

The following is an example of the search to be conducted on the PubMed database:

The following string will be filtered in PubMed including Case Reports, Classical Article, Clinical Study, Clinical Trial, Comparative Study, Controlled Clinical Trial, Multicenter Study, Observational Study, Pragmatic Clinical Trial, Preprint and Randomized Controlled Trial) and articles written in English only.

STRING (cartilage OR chondral OR osteochondral) AND knee AND (microfract* OR nanofract* OR drilling OR bone marrow stimulation OR mosaicplasty OR osteochondral autologous transplantation OR osteochondral allograft OR transplant OR autologous chondrocyte implantation OR matrix-associated OR matrix-assisted OR matrix-induced OR ACI OR MACI OR MACT OR AMIC OR minced cartilage OR paste grafting OR scaffold OR membrane)

Study selection will be separately performed by two reviewers AS, JS). A third reviewer SN) will be consulted to resolve disagreements amongst these reviewers and to facilitate consensus. The two reviewers will independently screen the titles and abstracts of the identified peer-reviewed articles to assess eligibility for inclusion in this review. Studies will be considered for inclusion based on their fulfilment of pre-specified eligibility criteria. Full-length texts of remaining peer-reviewed articles will be sought and reviewed in full to determine eligibility if reviewers are uncertain about their eligibility from title and abstract screening.
Data Extraction Data Charting Process)
A standardized data extraction sheet (created in Microsoft Excel) will be used to extract data. Data extraction will be blindly performed by two reviewers AS, JS, as part of a quality assurance process.
Data will be organized in the following manner:

Study Characteristics:

  1. study lead author
  2. study title
  3. journal
  4. year of publication
  5. study design
  6. level of evidence (using the Oxford, UK CEBM Levels of Evidence)

Participant characteristics:

  1. country in which the study was originally conducted
  2. sample size (total included participants, n = …)
  3. age of participants (mean age in years, standard deviation of age in years, age range)
  4. sex of participants (male OR female OR mixed (male and female); n-male %; nfemale %
  5. level of physical activity (method of quantification; levels)
  6. surgical intervention type.

Post-operative rehabilitation interventions that will emerge from the data extraction will be categorized into the following domains:

  • Time to start rehabilitation after surgery
  • Weight-bearing restrictions
  • CPM use Brace/Orthosis utilization
  • Pain management
  • Swelling management
  • Range of motion (ROM) restrictions
  • Rehabilitation interventions focused on regaining ROM
  • Manual therapy interventions
  • Interventions to resolve neuromuscular inhibition
  • Interventions to reduce muscle weakness (strengthening programs)
  • Static postural balance interventions
  • Dynamic postural balance interventions
  • Interventions to resolve altered movement patterns
  • Walking (progressions/regressions, criteria to return to)
  • Cycling (progressions/regressions, criteria to return to)
  • Jogging (progressions/regressions, criteria to return to)
  • Hopping (progressions/regressions, criteria to return to)
  • Agility (progressions/regressions, criteria to return to)
  • Deceleration rehabilitation/training (progressions/regressions, criteria to return to)
  • Psychological aspects
  • Criteria to be cleared for return to run RTR
  • Criteria to be cleared for return to restricted training RTT
  • Criteria to be cleared for return to sport RTS
Collating, Summarizing, and Reporting Results
All analyses will be conducted in Excel 2016 Microsoft Corporation, Redmond, WA. Median and ranges or mean ± SD values for continuous variables will be calculated where possible. Demographic information, post-operative restrictions (e.g., weightbearing, ROM, bracing and associated prescribed time frames, time to start rehabilitation since surgery, etc.), and rehabilitation indications regarding continuous passive motion, ROM, time to introduce close vs. open kinetic chain exercises, strengthening progressions, resumption of specific physical activities (e.g., walking, biking, swimming, jumping, hopping, etc.), and criteria for returning to running and sport will be collated and recorded in an Excel spreadsheet. Further analysis will be performed, such as the number of studies not reporting per all the rehabilitation domains but just partial ones or no one, analysis of rehabilitation outcomes domains per type of surgical procedure, analysis to track the overall evolution overtime (all type of surgical procedure combined) and per type of surgical procedure, separate analysis per level of evidence of the included studies, and analysis to investigate the previously mentioned potential differences filtered per single aspects/parts of the TIDieR and CERT checklists. To report the results in an easily accessible format, the elements of the post-operative rehabilitation programmes will be classified under the domains generated through the data-charting process. We will use the Template for the Intervention Description and Replication TIDieR) checklist (12 items) and the Consensus on Exercise Reporting Template (CERT) checklist (16 items, with two doubles = 18 items) to evaluate the transparency, completeness, quality of exercise-/non exercise-based interventions, and ultimately the clinical reproducibility of the rehabilitation interventions after surgical treatments for knee cartilage lesions of all included studies. Additionally, the median of the TIDieR and CERT scores of the studies specific to each domain (mTIDieR, mCERT) will be calculated checklists score of the single studies / the number of studies included per domain) to characterize the final reproducibility of each domain in clinical practice. We will use a “traffic light systemˮ (mTIDieR score from 0 to 4 = red light/not clear, mTIDieR 58 = yellow light/unclear, mTIDieR 912 = green light/clear and mCERT score from 0 to 6 = red light/not clear, mCERT 712 = yellow light/unclear, mCERT 1318 = green light/clear) to represent the transparency, completeness, quality, and clinical reproducibility of the delivered rehabilitation.
Funding
There is no funder or sponsor associated with this scoping review.