Post-Operative Rehabilitation Protocol

Osteochondral Autograft

This rehabilitation protocol has been developed for the patient with an osteochondral autograft (carticel) procedure.  It is of the utmost importance to protect this patient against high weight bearing forces during the early postoperative period to avoid shearing or disruption of the graft tissues.  Early passive range of motion within the allowed range is highly beneficial to enhance the cartilage and the remodeling process.  The protocol is divided into phases.  Each phase is adaptable based on the individual patient and special circumstances.

The overall goals of the surgical procedure and rehabilitation are to:

  • Control pain, swelling, and hemarthrosis
  • Regain normal knee range of motion
  • Regain a normal gait pattern and neuromuscular stability fro ambulation
  • Regain normal lower extremity strength
  • Regain normal proprioception, balance, and coordination for daily activities
  • Achieve the level of function based on the orthopedic and patient goals

The physical therapy should be initiated within 3 to 5 days post-op.  It is extremely important for the supervised rehabilitation to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility.  Important post-op signs to monitor:

  • Swelling of the knee or surrounding soft tissue
  • Abnormal pain response, hypersensitive
  • Abnormal gait pattern, with or without assistive device
  • Limited range of motion
  • Weakness in the lower extremity musculature (quadriceps, hamstring)
  • Insufficient lower extremity flexibility

Return to activity requires both time and clinical evaluation.  To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance.  Isokinetic testing and functional evaluation are both methods of evaluating a patient’s readiness to return to activity.  Return to intense activities following a carticel procedure may increase the risk of repeat injury or the potential of compounding the original injury.  Symptoms such as pain, swelling, or instability should be closely monitored by the patient.

Phase 1: Week 1-8

Osteochondral Autograft Procedure

WEEK   EXERCISE GOAL
1-8 ROM-Passive   0-90° (wk 4)
    Femoral condyle defect: 0-45°  
    Trochlear defect: 0-30°  
    Range of motion to increase to reach goals based on area of defect as noted by Dr. Lowe 0-1107° (wk 5)
0-120° (wk 8)
    Gastroc/Soleus stretch  
    Hamstring/ITB stretch  
    Heel/Wall slides to reach goal  
    Patella mobs  
    Ankle pumps  
  STRENGTH    
    Quad/Hamstring/Gluteal sets  
    Multi-angle isometric (0-60°) wk 4
    Multi-angle isometric (90-30°) wk 6-8
    SLR in all 4 planes as tolerated  
    Hip flexion  
    Selective ROM activity-depending on defect site as noted by Dr. Lowe  
    Trochlear repair- only isometric training with quads, NO active motion through range  
  WEIGHT BEARING    
    NWB with crutches NWB to PWB
(wk 6-8)
  BRACE    
    Locked at 0° extension for protection  
  MODALITIES    
    E-stim/biofeedback as needed  
    Ice 15-20 minutes  

GOALS OF PHASE:

  • ROM 0-120°
  • NWB to PWB with one crutch
  • Control pain, inflammation, and effusion
  • Adequate quad/VMO contraction

Phase 2: Week 8-36

Osteochondral Autograft Procedure

WEEK   EXERCISE GOAL
8-36 ROM   0-135°
    Passive, 0-135°  
    Patella mobs  
    Gastoc/Soleus stretch  
    Hamstring/ITB stretch  
    Heel/Wall slides to reach goal  
  STRENGTH    
    SLR in 4 planes with ankle wt/tubing  
    Mini-squats (0-30°)  
    Wall squats  
    Initiate 3-6” lateral/forward step-up/downs  
    Leg press (0-60°)/Total Gym  
    Knee extension (90-30°)  
    Hamstring curls (0-90°)  
    Multi-hip machine in 4 planes  
    Heel raise/Toe raise  
  BALANCE TRAINING    
    Weight shift (side-to-side, fwd/bkwd)  
    Initiate single leg balance work  
    Progress to wobble board, ½ foam roller  
    Single leg balance with plyotoss  
    Sportscord balance work  
  WEIGHT BEARING    
    NWB to PWB to FWB with quad control FWB (wk 8)
  BRACE   D/C (wk 6-8)
    Discharge by week 8 or as noted by Dr. Lowe  
  AEROBIC CONDITIONING    
    Bicycle when 110° flexion is reached  
    EFX for endurance  
    Treadmill with 2-3% incline to reduce joint loads  
    Swimming (as noted by Dr. Lowe)  
  MODALITIES    
    Ice 15-20 minutes  

GOALS OF PHASE:

  • PWB to FWB with quad control
  • ROM 0-135°
  • Increase lower extremity strength and endurance
  • Control pain and inflammation
  • Enhance proprioception, balance, and coordination

Phase 3: Week 36-52

Osteochondral Autograft Procedure

WEEK   EXERCISE
36-52 ROM  
    Continue all stretching activities from previous phases
  STRENGTH  
    Continue all strengthening activities from
previous phases increasing weight and repetition
Reverse/Lateral lunges
Straight leg dead lift
Stool crawl
  BALANCE TRAINING  
    Advance to dynamic balance work with different surfaces
  RUNNING/CONDITIONING PROGRAM  
    Initiate running on minitramp, progress to treadmill as tolerated in a straight plane
Initiate jump rope for endurance and impact
Initiate walking program for endurance
Swimming (kicking)
Bicycle for endurance
Continue to increase time and resistance on the above
  FUNCTIONAL TRAINING  
    Initiate light plyometric work
Initiate lateral movement (shuffle, slide board)
Initiate sport specific/functional drills at month 6
Progress into sport training at month 9
  MODALITIES  
   

Ice 15-20 minutes as needed

GOALS OF PHASE:

  • Maintain full range of motion
  • Maximize lower extremity strength and endurance
  • Initiate sport specific activity
  • Initiate functional activity