Osteochondral Allograft Implantation

Phase I (Weeks 0-6)

1. Weightbearing:  Non-weightbearing
2. Bracing:Hinged knee brace locked in extension (week 1) – remove for CPM and rehab with PTWeeks 2-6: Gradually open brace in 20° increments as quad control is obtainedD/C brace when patient can perform straight leg raise without an extension lag
3. Hinged knee brace locked in extension (week 1) – remove for CPM and rehab with PT
4. Weeks 2-6: Gradually open brace in 20° increments as quad control is obtained
5. D/C brace when patient can perform straight leg raise without an extension lag
6. Range of Motion – Continuous Passive Motion (CPM) Machine for 6-8 hours per day for 6-8 weeksSet CPM to 1 cycle per minute – starting at 40°of flexionAdvance 10° per day until full flexion is achieved (should be at 100° by week 6)PROM/AAROM and stretching under guidance of PT
7. Set CPM to 1 cycle per minute – starting at 40°of flexion
8. Advance 10° per day until full flexion is achieved (should be at 100° by week 6)
9. PROM/AAROM and stretching under guidance of PT
10. Therapeutic ExercisesPatellar mobilizationQuad/Hamstring/Adductor/Gluteal sets – Straight leg raises/Ankle pumps 
11. Patellar mobilization
12. Quad/Hamstring/Adductor/Gluteal sets – Straight leg raises/Ankle pumps 

Phase II (Weeks 6-8)

1. Weightbearing:  Partial weightbearing (25% of body weight)
2. Range of Motion – Advance to full/painless ROM (patient should obtain 130° of flexion)
3. Therapeutic ExercisesContinue with Quad/Hamstring/Core strengtheningBegin stationary bike for ROM
4. Continue with Quad/Hamstring/Core strengthening
5. Begin stationary bike for ROM

 Phase III (Weeks 8-12)

1. Weightbearing:  Gradually return to full weightbearing
2. Range of Motion – Full/Painless ROM
3. Therapeutic ExercisesBegin closed chain exercises – wall sits/shuttle/mini-squats/toe raisesGait trainingContinue with Quad/Hamstring/Core strengtheningBegin unilateral stance activities
4. Begin closed chain exercises – wall sits/shuttle/mini-squats/toe raises
5. Gait training
6. Continue with Quad/Hamstring/Core strengthening
7. Begin unilateral stance activities

Phase IV (Months 3-6)

1. Weightbearing:  Full weightbearing with a normal gait pattern
2. Therapeutic exerciseAdvance closed chain strengthening exercises, proprioception activitiesSport-specific rehabilitation – jogging at 4-6 monthsReturn to athletic activity – 9-12 months post-opMaintenance program for strength and endurance
3. Advance closed chain strengthening exercises, proprioception activities
4. Sport-specific rehabilitation – jogging at 4-6 months
5. Return to athletic activity – 9-12 months post-op
6. Maintenance program for strength and endurance