Gel-Based Autologous Chondrocyte Implantation in a Patient with Noncontained Osteochondral Knee Defect at 9-Year Follow-Up
Table 1
Rehabilitation protocol of ACI in our center.
Sr. no.
Phases of rehabilitation protocol
1
Phase I (weeks 0-12)
Weight-bearing (i) Weeks 0-3: non-weight-bearing (ii) Weeks 4-6: partial weight-bearing (30-40 lbs) with progressive use of crutch (iii) Weeks 7-12: progress to full weight-bearing with discontinuation of crutch use
Bracing (i) Weeks 0-2: hinged knee brace locked in extension—remove for continuous passive motion (CPM) and rehab with PT (ii) Weeks 2-4: gradually open brace at 20° intervals as quad control is obtained
Range of motion (i) CPM machine functional for 4-6 hours every day for 6 weeks (ii) Set the CPM to 1 cycle per minute—set initially at 0-30° (iii) Increase flexion 5-10° per day until full flexion is achieved (iv) Should be at 90° by week 4 and at 120° by week 6
Therapeutic exercises (i) Weeks 0-2: straight leg raise/quad sets and hamstring isometrics (ii) Perform exercises in the brace if quad control is inadequate (iii) Weeks 2-6: begin progressive isometric closed chain exercises (iv) At week 6, start weight-shifting activities with operative leg in extension (v) Weeks 6-10: progress bilateral closed chain strengthening and begin open chain knee strengthening (vi) Week 12: begin balance exercises and stationary bike with light resistance
2
Phase II (weeks 12-24)
Weight-bearing: full weight-bearing with a normal gait pattern
Range of motion: advance to full/painless ROM
Therapeutic exercises (i) Advance bilateral and unilateral closed chain exercises with emphasis on concentric/eccentric control (ii) Stationary bike/treadmill/stairmaster/elliptical (iii) Progress balance/proprioception exercises (iv) Start sport cord lateral drills
3
Phase III (months 6-9)
Weight-bearing: full weight-bearing with a normal gait pattern
ROM: advance to full/painless ROM
Therapeutic exercises (i) Advance strength training (ii) Start jogging and sport-specific training at 6 months
4
Phase IV (months 9-18)
Weight-bearing: full weight-bearing with a normal gait pattern
ROM: full/painless
Therapeutic exercises (i) Continue closed chain strengthening exercises and proprioception activities (ii) Sport-specific rehabilitation—running/agility training at 9 months (iii) Return to impact athletics—16 months (if pain-free)
