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 (this 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

Week 1:

• M.D. 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/adduction/gluteal sets, 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

• M.D. 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 (i.e. unilateral cycling, UBE, Schwinn Air-Dyne arms only)
• AFTER 2 weeks, bilateral cycling with light to no resistance

• M.D. visit at 4 weeks post-op, will progress to full weightbearing and discontinue use of rehab brace
• Incorporate functional exercises (i.e. 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)

• 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

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