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Articular cartilage transplant to the trochlea rehab protocol

General Considerations

  • Weight bearing as tolerated in full extension with brace for 4 weeks post-operatively.
  • Patients are cleared to drive once they are off all narcotic pain medications typically around week 2, or if cleared by Physical Therapist. Can unlock brace while in car.
  • Regular manual treatment should be conducted to decrease the incidence of fibrosis.
  • Regular stretching of the posterior musculature is important to prevent a flexion contracture. Although ambulating in full extension, some loss of motion prior to surgery is not uncommon.
  • Imperative to work on recruiting VMO throughout the rehab process.
  • No resisted leg extension machines (isotonic or isokinetic) at any point.
  • No patella mobs for 4 weeks.
  • Low impact activities for 3 months post-operatively.
  • Use of the CPM (Continuous passive machine) for 6 hours a day for 4 weeks. Range of motion is 0-100 degrees for the first 4 weeks. Gradually work up to 100 degrees as patient tolerates.
  • Avoid direct palpation of the surgical portals for 4 weeks. Consider the edges of the bandages as the “do not touch” zone (approximately 2” in all directions from each portal).

Week 1

  • Nurse visit day 2 post-op to change dressing and review home program.
  • Icing and elevation regularly per icing protocol.
  • Continuous passive machine (CPM) at home for 6 hours daily during wake hours.

Manual

  • Soft tissue mobilization (STM) to quadriceps, posterior musculature, suprapatellar pouch, popliteal fossa, ITB (iliotibial band), Hoffa’s fat pads.
  • No patellar mobs x 4 weeks.
  • No direct palpation of surgical portals x 4 weeks.

Exercises

  • Well-leg stationary cycling, upper body ergometer (UBE).
  • Straight leg raises (standing, supine, side lying), quadriceps/ gluteal sets, hip and ankle exercises.
  • Seated dangle with opposite leg support within appropriate range of motion.

Goals

  • Passive range of motion 0 to 70 degrees.
  • Gait weight bearing as tolerated in full extension brace x4 weeks post op.

Weeks 2 - 4

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

Manual

  • Continue with soft tissue mobilization to quad, posterior musculature, suprapatellar pouch, popliteal fossa, ITB, Hoffa’s fat pads.
  • No patellar mobs x4 weeks.
  • No direct palpation of surgical portals x4 weeks.

Exercises

  • Proprioception exercises.
  • Non weightbearing aerobic exercises (i.e. unilateral cycling, UBE, single leg row machine).
  • Manual resisted proprioceptive neuromuscular facilitation patterns of the foot, ankle and hip.

Goals

  • Passive range of motion 0 to 100 degrees.
  • Gait weight bearing as tolerated in full extension brace x4 weeks.

Weeks 4 - 6

  • M.D. visit at 4 weeks post-operative, wean off use of rehab brace.

Manual

  • Continue with soft tissue mobilization to quadriceps, posterior musculature, suprapatellar pouch, popliteal fossa, ITB , Hoffa’s fat pads.
  • Can initiate gentle patellar mobilizations and scar mobilization if incisions closed > 4 weeks post op.

Exercises

  • Incorporate functional exercises (i.e. short arc squats, slider lunges, shuttle squats/Pilates board squats and exercises, calf raises). Balance/proprioception exercices.
  • Progress into bilateral stationary cycling and continue to add light resistance as tolerated.
  • Slow to rapid walking on treadmill (preferably a low-impact treadmill).
  • Pool/deep water workouts once surgical portals are completely closed.

Goals

  • Knee flexion 110 degrees.
  • Gait: full weight bearing, unlock brace/wean off brace, focus good mechanics with minimal assistive device.

Weeks 6 - 8

Manual

  • Continue with soft tissue mobilization and scar tissue mobilization as needed.

Exercises

  • Bilateral stationary cycling and progress to road cycling on flat roads.
  • Initiate pool/deep water exercises.
  • Gradually increase the range of motion of closed- and open-chain exercises.
  • Add lateral training exercises (i.e. side-stepping, Theraband resisted sidesteps) once adequate strength has been demonstrated.

Goals

  • Patients should be walking without a limp. Range of motion 0 to 120 degrees.
  • Ascend stair step at 8 inch height.

Weeks 8 - 12

Manual

  • Continue with soft tissue mobilization and scar tissue mobilization as needed.

Exercises

  • Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weight lifting machines for upper body, avoid loading with knee flexion type activities- weighted squats).
  • Road cycling as tolerated, remain in saddle, slow cadence, no clip in type shoes until > 12 weeks.

Goals

  • Full range of motion symmetrical to opposite lower extremity.
  • Descend stair step at 8 inch height, descend hills with good control.

Weeks 12+

  • Sports Test 1 at 12 weeks
  • Continue with strengthening, endurance, balance, and sport specific training.
  • Increase intensity of low impact type cardio- swimming, cycling, elliptical,etc.
  • No high impact activities until 1 year unless approved by MD.

6 months +

  • Appointment with MD. Will receive further instructions at this time.

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.

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