PROTOCOL FOR OSTEOCHONDRAL ALLOGRAFT TRANSPLANTATION IN THE KNEE

1^st Week After Surgery:

• Keep surgical dressing in place until follow up appointment and do not get wet
• Elevate operative extremity above the level of the heart as often as possible
• Apply ice to the operative knee for 20 minutes at a time at least five times a day
• Begin CPM machine the day after surgery
• Brace locked in extension at all times except when using CPM machine
• DVT prevention:
  • 1 tablet 325 mg aspirin per day (obtain over the counter)

Phase I

0 to 6 Weeks

Main goals:

1. Graft incorporation into native bone
2. Early range of motion

Weightbearing/Brace:

• Weightbearing – heal touch
• Brace
  • Weeks 0 – 2
    • Worn in extension at all times except during strengthening exercises or CPM use
  • Weeks 2 – 6
    • Worn at all times but allow full flexion and extension
• Continuous Passive Motion (CPM) Machine
  • Use 6 hours per day
  • Start at 0° to 40° 
  • Increase 5° to 10° per day
  • Goal on CPM is to be at 100° by Week 6

Exercises:

• Passive and active range of motion exercises as tolerated at 2 weeks post op
• Emphasis on strengthening and mobilization

Phase II

6 to 8 Weeks

Main Goals:

1. Progress to full weightbearing
2. Obtain full range of motion

Weightbearing:

• Initiated at 25% of weight
• Advance by 25% each week to full weightbearing

Range of Motion:

• Increased daily to goal of 130° of flexion

Exercises:

• Improve strength, flexibility, and neuromuscular control
• Initiate cardio

Phase III

8 – 12 Weeks

Main goals:

1. Restore flexibility, strength, flexibility, and neuromuscular control
2. Full pain-free range of motion

Exercises:

• Initiate gate training
• Closed chain exercises
• Initiate unilateral stance exercises

Phase IV

12 Weeks to 6 Months

Main Goals:

1. Full, pain-free range of motion 
2. Normal gait with full weightbearing

Exercises:

• Advance strength training as tolerated
• Advance to single-leg curls and extensions by 14 to 16 weeks

Phase V

6 to 12 Months

Main Goals:

• Regain high levels of proprioception, strength, neuromuscular control, and flexibility

Exercises:

• Sport-specific training

Return to Play:

• Typically 6 – 8 months after surgery
• General criteria:
  1. Full active range of motion without apprehension
  2. Operative extremity within 10% of contralateral extremity on isokinetic testing