Physio Fitaal in Tilburg at

Cartilage rehabilitation.


At Fysio Fitaal in Tilburg, we specialize in assisting with rehabilitation after cartilage surgery. Rehabilitating from surgery through physical therapy can be challenging and impactful. Fysio Fitaal makes rehabilitation after cartilage surgery insightful and manageable. Our practice is fully equipped to help you recover well after surgery. Together with you, we draw up a treatment plan for lasting results. Because of our expertise, we are familiar with all kinds of protocols and rules in the various phases of rehabilitation after surgery.

Anterior cruciate ligament rehabilitation by physiotherapist in Tilburg
When do we speak of cartilage damage?

    Only the orthopedist or surgeon can use imaging studies to form a decision about whether the symptoms are appropriate for cartilage damage. To get a good and reliable picture of the damage to the cartilage, imaging studies are necessary. Should this not be sufficient, it can be decided to additionally perform keyhole surgery (arthroscopy) to get a better picture of the severity of the cartilage injury. 

    Cartilage damage can be classified into five different degrees according to the scoring system of the "International Cartilage Repair Society. 

    • Grade I: soft site with less resistance than the surrounding, healthy cartilage.
    • Grade II: superficial tears or defects in the cartilage surface, less than half the total thickness.
    • Grade III: deep cracks or fissures in the cartilage surface, more than half the total thickness.
    • Grade IV: tear to the subchondral bone, affecting the total thickness of the cartilage surface.
    • Grade V: impairment of the total thickness of the cartilage surface with involvement of the subchondral bone ("full-thickness defect").

    In addition to an MRI, additional x-rays are necessary to get a good picture of the situation. Consider ruling out any loose bone fragments and determining signs of osteoarthritis.

    Restoring or improving the quality of the affected cartilage tissue can be done with various surgical techniques. Below we explain the four most common techniques from which we may perform many rehabilitations in our physiotherapy practice in Tilburg.

    Autocart procedure

    AutoCart is a surgical procedure, in which cartilage lesions are treated using only the patient's own material/tissue. This involves using a SabreTooth shaving blade to remove 3 or 4 mm cartilage particles. These are then collected in the GraftNet device and then transferred into a 1 ml application syringe. After mixing with some PRP, the particles are inserted into the lesion using an application cannula and then fixed with autologous thrombin solution produced by the thrombonator device. At the end, the entire construct is sealed with an additional layer of a PRP/Trombin mix.

    An autocart procedure is regularly performed by Bergman Clinics which we work closely with as a practice.

    Microfracture (=Icepicking)

    Microfracture is a technique used to treat cartilage injuries. In this surgery, holes are made in the underlying bone to allow stem cells from the bone marrow to repair the cartilage defect. This technique is usually used if the defect has not been previously treated and is no larger than 1 to 1.5 cm2. It is done through keyhole surgery.

    Depending on the location of the cartilage injury, patients often need to use crutches to walk unloaded/without support for 6 weeks. In some cases, patients can load their knee, but must use a brace to keep the knee extended while walking for 6 weeks. 


    Prof. Marcel Karperien and his colleagues at the TechMed Centre at the University of Twente, with support from ReumaNederland, have developed a hydrogel in which damage to cartilage can possibly be repaired. Through keyhole surgery, the damaged cartilage can be filled by an injection of the hydrogel. This gel is liquid so that the damaged surface can be perfectly filled. After various studies in which the hydrogel was tested on horses, among others, the hydrogel has now also been tested on humans for the first time.

    The hydrogel is currently being further developed by the company Hy2Care, of which Marcel Karperien is one of the founders. This company, together with the orthopedists of the UMC Utrecht, now doing initial tests on several dozen people. Should this method of cartilage repair for defects smaller than 2cm2 prove successful, it may be possible to investigate the effect of this method in complaints such as osteoarthritis.


    Fysio Fitaal is currently assisting one of the first patients in the Netherlands with a hydrogel repair. 

    Autologous Chondrocyte Implantation or Transplantation (ACI or ACT) 

    This type of cartilage transplant is used for larger cartilage defects. The treatment consists of two procedures. In the first procedure, 2 or 3 small particles of cartilage are first taken from a relatively unloaded area of the joint through keyhole surgery. The cartilage cells are then grown in a laboratory. When there are enough new cells, we can proceed to the second operation/surgery.

    In the second keyhole surgery/operation, the new cartilage cells are placed in the cartilage defect. This is usually about 6 weeks after the first surgery. 

    The drug used in this procedure is "Spherox. Spherox consists of spheres. These spheres are formed from cartilage cells grown by a special method. The cartilage defect is cleaned and the damaged tissue is removed. Then the spheres are applied to the cleaned cartilage. The globules adhere to the cartilage within about 20 minutes. 

    ACI procedure is carried out regularly by the ETZ Tilburg/Waalwijk which we as a practice work closely with. The ETZ is one of the 4 cartilage centers in the Netherlands.

    After all these surgeries, long-term and intensive physical therapy is needed to ensure that cartilage repair proceeds properly. Cartilage always recovers very slowly, so loading the knee too quickly can negate the effect of the surgery. It is also important to exercise the knee properly so that it does not become stiff and you can regain full use of it. In total, this rehabilitation takes about one year. 

    Remote consultation

    Are you looking for expert advice regarding an upcoming cartilage rehabilitation but is distance a barrier? We would be happy to share our expertise and experience through a digital consultation. The physiotherapists at Fysio Fitaal in Tilburg have a lot of experience in guiding and rehabilitating cartilage injuries. We would like to provide you with all the necessary information and advice to successfully rehabilitate. 

    During the digital consultation, you will have plenty of time to ask questions or share any concerns you may have. We listen attentively and adapt our advice to your specific situation. There is also the possibility to come to a customized rehabilitation plan in cooperation with your treating physiotherapist. Taking into account the medical history, goals and physical condition. 

    Our approach is a combination of known scientific knowledge and our own practical experience. You can be confident that the advice and rehabilitation protocol is based on the latest developments within the field. 

    How does it work? 

    1. Schedule Appointment: Please contact us using the contact form to schedule an appointment for your digital consultation. Preferably, we use ZOOM. 
    2. Preparation: When the appointment is scheduled you will receive an email from us asking you to send us relevant medical information and documentation so that we can properly prepare for our interview. 
    3. The consultation During the digital consultation we will go over the situation with you, all your questions you have can be asked during this mo ment and we will give advice on what steps you can go through during your rehabilitation. 
    4. Follow-up: After the consultation you will receive a summary of the conversation and the suggested treatment plan. We are of course available to you for any further questions or if desired physical guidance during the course. 
    5. Evaluation: Our advice is to schedule an evaluation moment every 12 weeks. This can be done online, but you are also welcome in our physiotherapy practice in Tilburg. We work with a unique test and measurement system mainly based on mapping left-right differences and norm values related to strength and mobility. 

    So if you live farther away but still want to use our expertise, don't hesitate and contact us! Together we will work on your recovery with a thoughtful plan, regardless of distance.

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    the fital method

    A phased treatment

    in cartilage injuries

    Successful rehabilitation consists of several stages and steps. Proper strength, stability and control of the knee is necessary to safely return to your sport. Both after an operative procedure and with a conservative policy. For this we use our specialized FITAAL method, with the result that you will be able to progress again under your own steam.

    This is how we treat cartilage injuries:

    1. Fit.

    In this phase, we focus primarily on symptom reduction. There is often swelling, pain and reduced mobility of the knee. In addition, it is important to regain good control of your quadriceps(upper leg muscle). After a cartilage injury or surgery on that knee, we often see a significant decrease in quadriceps strength and mass. So it is critical to quickly regain proper function of the quadriceps. In addition, it is important to return to a normal gait pattern.

    2. Forward

    In this phase, there is more of a build-up in strength. Stabilizing exercises also come into play. In the meantime you may work on your general condition. This makes you improve your mobility and vitality by leaps and bounds.

    3. Final

    The final stage involves working with you to see what possibilities remain with regard to sports/hobbies. 

    What does the health insurance company reimburse? 

    Physiotherapy following surgery is reimbursed only when a condition is on the chronic list of physical therapy. For example, surgery due to a bone fracture or after surgery on your knee, think about repairing your anterior cruciate ligament or placing a knee replacement. You also need a referral from the doctor. Also, you always pay the deductible. However, this is often already consumed because of the cost of the surgery. What else is important to know:

      • The authorization runs up to 12 months after the start of rehabilitation(the first physical therapy treatment)
      • The insurer will reimburse all costs starting from the 21st treatment
      • The first 20 treatments come out of your supplementary package to the extent possible

    Are you having trouble figuring it out? Then contact us. We'll be happy to take a look with you!

    Fysio Fitaal has three locations. Our first physio practice is located in Tilburg Centrum, at Veldhovenring 57. Our second location is located in Tilburg Reeshof, at Spaubeekstreet 89 near the Basic-Fit gym. Our third location is located in a health center in Tilburg West, at Professor Verbernelaan 37-D.

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