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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.