Osteochondral Allograft Rehabilitation Protocol
Phase 1 (0-6 weeks)
- Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
- Modalities: Compressive cyrotherapy, e-stimulation
- Weightbearing: Non-weight-bearing
- Brace:
- Locked in full extension at all times initial 48 hours (2 days).
- ROM opened 0-90° from day-2 through 4 weeks
- ROM opened to full, 0-120° weeks 4-6.
- ROM:
- The first priority is to focus on regaining terminal extension.
- Advance knee flexion ROM 5-10° daily as tolerated with goal of 90° within 2-3 weeks.
- Exercises:
- 0-2wks: Quad sets, SLR, calf pumps, passive leg hangs to 90° at home
- 2-6wks: PROM/AAROM to tolerance, patella and tibiofibular joint mobs, quad, hamstring, and glute sets, SLR, side-lying hip and core
Phase 2 (6-8 weeks)
- Weightbearing: Advance 25% weekly until full weightbearing. Instruct patient to recognize maladaptive gait.
- Brace: Begin to wean from brace after 6 weeks. Advocate to continue in uncontrolled settings or adverse weather.
- ROM: Full
- Exercises: Advance phase 1 exercises. Progress weightbearing flexibility, begin toe raises and closed chain quad work. Begin floor-based core and gluteal work, balance exercises, hamstring curls and stationary bike
Phase 3 (8-12 weeks)
- Weightbearing: Full
- Brace: None
- ROM: Full
- Exercises: Gait training, begin closed chain activities; wall sits, shuttle, mini-squats, toe raises. Begin unilateral stance activities, balance training
Phase 4 (12wks – 6mo)
- Weightbearing: Full
- Brace: None
- ROM: Full
- Exercises: Advance phase 3 exercises; maximize core/glutes, pelvic stability work, and eccentric hamstrings. May advance to elliptical, bike, pool as tolerated.
Phase 5 (6-12mo)
- Weightbearing: Full
- Brace: None
- ROM: Full
Exercises: Advance functional activity. Return to sport-specific activity and impact when cleared by MD after 8mo.