Articular Cartilage Stem Cell Paste Graft Rehabilitation Protocol

General Considerations:
• Nonweightbearing status for 4 weeks post-op. Resting foot on floor and driving are okay.
• Most patients will be in a hinged neoprene brace for support and to serve as a reminder not to bear any weight on that limb.
• Depending on the location of the articular cartilage defect and subsequent graft, patients may have active and/or passive range of motion restrictions, which will be noted on the prescription. Otherwise, push for full hyperextension equal to opposite side.
• Regular manual treatment should be conducted to the patella and all incisions--with particular attention to the anterior medial portal--to decrease the incidence of fibrosis.
• Light-to-no-resistance stationary cycling is okay at 2 weeks post-op.
• Early recruitment of the vastus medialis muscle will speed recovery.
• No resisted leg extension machines (isotonic or isokinetic).
• Low-impact activities for 3 months post-op.
• 1500 mg of glucosamine sulfate daily via Joint Juice® or other sources.

*Use of the CPM for 6 hours a day for 4 weeks is imperative.

 Week 1:
• MD visit Day 1 post-op to change dressing and review home program.
• Icing and elevation regularly.
• CPM at home for 6 hours daily/at night.
• Straight leg raise exercises (lying, seated, and standing), quadricep/adductio/gluteal sets, and passive and active range of motion exercises.
• Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.
• Pool/deep water workouts after the first 2 days and with the use of a brace if any ROM restrictions.
• Soft tissue treatments and gentle mobilization to posterior musculature, patella, and incisions.

Weeks 2 - 4:
• Clinic visit at 8 - 10 days for suture removal (if any) and check-up.
• Manual resisted (PNF patterns) of the foot, ankle and hip.
• Continue with pain control, range of motion, soft tissue treatments, and proprioception exercises.
• Nonweightbearing aerobic exercises such as unilateral cycling, UBE, Schwinn Air-Dyne arms only.
• AFTER 2 weeks, bilateral cycling with light-to-no-resistance.

Weeks 4 - 6:
• MD visit at 4 weeks post-op, will progress to full weightbearing, and discontinue use of rehab brace.
• Wedge in the shoe may be indicated to mechanically unload the femoral condyle.
• Incorporate functional exercises such as squats, linebackers, lunges, Shuttle/leg press, calf raises, step-ups/lateral step-ups.
• Balance/proprioception exercises.
• Road cycling as tolerated.
• Slow-to-rapid walking on treadmill; preferably a low-impact treadmill.

Weeks 6 - 8:
• Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines).
• Add lateral training exercises (side-stepping, Theraband resisted side-stepping, lateral leaping onto toes as tolerated).
• Patients should be walking without a limp and range of motion should be at least 90% of normal.

Weeks 8 - 12:
• Low-impact activities until 12 weeks.
• Patients should be pursuing a home program with emphasis on sport/activity-specific training.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.