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

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


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/adductio/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


Weeks 2 - 4:

•    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


Weeks 4 - 6:

•    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)


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