REHABILITATION PROTOCOL:AUTOGOUS CHONDROCYTE IMPLANTATION (MACI) (TROCHLEA/PATELLA)

Phase I (Weeks 0-12)

• Weightbearing:

• Weeks 0-2: Non-weightbearing

• Weeks 2-4: Partial weightbearing (30-40 lbs)

• Weeks 4-8: Continue with partial weightbearing (progress to use of one crutch at weeks 6-8)

• Weeks 8-12: Progress to full weightbearing with discontinuation of crutch use

• Bracing:

• Weeks 0-2: Hinged knee brace locked in extension-remove for CPM and rehab with PT

• Weeks 2-4: Locked in extension for weightbearing – Can open brace for NWB ROM 0-30°

• Weeks 4-6: Open brace to 30° for ambulation

• D/C brace at 6 weeks post-op

• Range of Motion – Continuous Passive Motion (CPM) Machine for 6-8 hours per day for 8 weeks

• Set CPM to 1 cycle per minute – set at 0-30° for first 3 weeks

• Starting at week 3 increase flexion 5-10° per day until full flexion is achieved

• Should be at 90° by week 6 and 120° by week 8

• PROM/AAROM and stretching under guidance of PT

• Therapeutic Exercises

• Weeks 0-4: Straight leg raise/Quad sets, Hamstring isometrics

• Perform exercises in the brace if quad control is inadequate

• Weeks 4-10: Begin isometric closed chain exercises

• At week 6 can start weight shifting activities with operative leg in extension

• At week 8 can begin balance exercises and stationary bike with light resistance

• Weeks 10-12: hamstring strengthening, theraband resistance exercises 0-30°, light open-chain knee isometrics

Phase II (Weeks 12-24)

• Weightbearing: Full weightbearing with a normal gait pattern

• Range of Motion – Advance to full/painless ROM

• Therapeutic Exercises

  • Gait training/treadmill use at slow-moderate pace

  • Progress balance/proprioception exercises

  • Start sport cord lateral drills

Phase III (Months 6-9)

• Weightbearing: Full weightbearing with a normal gait pattern

• Range of Motion – Advance to full/painless ROM

• Therapeutic Exercises

  • Advance closed chain strengthening/Start unilateral closed chain exercises

  • Progress to fast walking and backward walking on treadmill (add incline at 8 months)

  • Start light plyometric exercises

Phase IV (Months 9-18)

• Weightbearing: Full weightbearing with a normal gait pattern

• Range of Motion – Full/painless ROM

• Therapeutic Exercises

  • Continue closed chain strengthening exercises and proprioception activities

  • Emphasize single leg loading

  • Sport-specific rehabilitation – running/agility training at 9 months

  • Return to impact athletics – 16 months (if pain free)

• Maintenance program for strength and endurance