No abstract

There is an extensive amount of research and literature discussing the role of various nutrients throughout the wound healing process. Despite the importance of nutrition in wound healing, dietary protocols often remain absent from wound care standards. This may be due to a lack of comprehensive literature that summarises the complexities and considerations associated with nutrient deficiency and supplementation into an easily accessible and inclusive reference tool. The purpose of this review is to assess the nutrients with key roles in the wound healing process, and subsequently provide information that enables optimisation of nutrition in wound healing. The goal is to consolidate the complexities associated with this topic into a simple, easy-to-use reference tool. We have identified the most important nutrients required for optimal wound healing and condensed the findings into an inclusive chart to be utilised in a clinical setting. This reference tool will include patient populations at risk of deficiency, the stage of wound healing in which each nutrient is required, delivery method and recommended daily intake, outpatient recommendations for rich food sources of each nutrient, and considerations associated with each nutrient.

Objective The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee. Design Online postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. Results A total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Conclusion A minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.