You are here

Articular cartilage paste graft rehab protocol

General Considerations

  • Progression should be based on careful monitoring by the Physical Therapist of the patient’s functional status.
  • Patients are cleared to drive once they are off all narcotic pain medications typically around week 2, or if cleared by Physical Therapist.
  • Non-weight bearing status for 4 weeks post-op (resting foot on floor and driving are okay).
  • No direct palpation to surgical portals for 4 weeks. Consider the edges of the bandages as the “do not touch” zone (approx. 2” in all directions from each surgical portal).
  • Push for full extension equal to opposite side.
  • Regular manual treatment should be conducted to the patella and soft tissue (except around portals) to decrease the incidence of fibrosis.
  • Light to no resistance stationary cycling is okay at 2 weeks post-op (low cadence, low resistance).
  • Early restoration of neuromuscular quad control is important.
  • No resisted leg extension machines (isotonic or isokinetic) at any point.
  • Low impact activities for 3 months post-op.
  • Daily 1500 -3000 mg of Glucosamine Sulfate via Joint Juice or other sources.
  • *Use of the continuous passive motion machine (CPM) for 6 hours a day for 4 weeks is imperative. Range of motion to be determine by MD based on location of repair.

Week 1

  • Nurse visit day 2 post-op to change dressing and review home program.
  • Icing and elevation for 15-20 min every 2 hours per icing protocol.
  • Continuous passive motion machine (CPM) at home for 6 hours daily/at night.

Manual

  • Soft tissue mobilization to quadriceps, posterior musculature, suprapatellar pouch, popliteal fossa, iliotibial band, Hoffa’s fat pads.
  • Patellar mobilizations.
  • Avoid direction palpation to portals x 4 weeks.

Exercises

  • Well-leg stationary cycling (light to no resistance), upper body ergometer.
  • Range of motion exercises (passive/active), quadriceps/ gluteal sets, straight leg raises (lying, seated, side-lying and standing), hip/foot/ankle exercises.
  • Sit at edge of bed and allow knee to bend to 90 degrees or less for 5 minutes 4x/day in pain-free range.

Goals

  • Knee range of motion 0 to 90 degrees.
  • Pain <3/10.
  • Minimal edema.
  • Gait non-weight bearing x 4 weeks.

Weeks 2 - 4

  • Nurse visit at 14 days for suture removal and check-up.

Manual

  • Continue with soft tissue mobilization to quadriceps, posterior musculature, suprapatellar pouch, popliteal fossa, iliotibial band , Hoffa’s fat pads.
  • Manual resisted (PNF patterns) of the foot, ankle and hip; core stabilization.

Exercises

  • Non-weightbearing aerobic exercises (i.e. unilateral cycling, upper body ergometer, Schwinn Air-Dyne arms only).
  • AFTER 2 weeks, bilateral cycling with light to no resistance, low spin cadence.

Goals

  • Knee range of motion 0 to 100 degrees.
  • Gait non-weight bearing x 4 weeks.

Weeks 4 - 6

  • M.D. visit at 4 weeks post-op, will progress to full weight bearing weaning down to 1 crutch, cane, or no assistive device.

Manual

  • Continue with previous soft tissue mobilization, initiation of scar mobilization to closed surgical portals.

Exercises

  • Incorporate functional exercises (i.e. squats, lunges, Shuttle/leg press, calf raises, step-ups/lateral step-ups).
  • Balance/proprioception exercises.
  • Slow to rapid walking on treadmill (preferably a low-impact treadmill).
  • Progress knee flexion range of motion.

Goals

  • Knee range of motion 0 to 120 degrees.
  • Tolerate increased functional exercises/strengthening.
  • Gait weight bearing as tolerated work towards good quality gait with least amount of assistive device.

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).

Goals

  • Patients should be walking without a limp.
  • Full active range of motion.

Weeks 8 - 12

  • Continue with strengthening; progress balance exercises with emphasis on dynamic tasks.
  • Patients should be pursuing a home program with emphasis on sport/activity-specific training.
  • Road cycling as tolerated starting in saddle, flat surface; progress cautiously.

Weeks 12+

  • Complete Sport Test 1.
  • Continue with strengthening, endurance, balance, and sport specific training.
  • Increase intensity of low impact type cardio- swimming, cycling, elliptical,etc.
  • No high impact activities X 1 year unless approved by MD.

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.

Avoid joint replacement
You are told you have knee arthritis. The advice the doctor gives you is to go home, rest your knee, take anti-inflammatory drugs, lose some weight, wait until you are older and then get an artificial knee replacement. This advice is awful. Here's why.
Many elements contribute to top athletic performance. Some are obvious—like diet and training—but another factor is more subtle.
To help you find a good physical therapist, here’s a guide to what we look for when hiring PTs, outlining the skills we expect them to bring to the patient and to the doctor.
July 14th, 2015
In light of Wes Matthews and other NBA athletes suffering Achilles ruptures, Dr. Stone speaks to Mavs Moneyball, a...
April 27th, 2016
Dr Stone talking about Steph Curry's injury and the Warrior's season.
December 11th, 2014
"A few select orthopedic surgeons and researchers around the country are pioneering alternate cartilage...

Stone, K.R., A.W. Walgenbach, A. Freyer, T.J. Turek, and D.P. Speer. 2006.

Stone, K.R., A.W. Walgenbach, T.J. Turek, A. Freyer, and M.D. Hill. 2006.