MACI – Matrix-Assisted Autologous Chondrocyte Implatantation – Femoral Condyle Rehab Protocol

Phase 1 (0-6 weeks)

Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
Modalities: Compressive cyrotherapy, e-stimulation
Weightbearing: Non-weightbearing
Brace:
- Locked in full extension at all times for 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:
- 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

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.

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

Weightbearing: Full
Brace: None
ROM: Full
Exercises: Advance phase 3 exercises; maximize core/glutes, pelvic stability work, eccentric hamstrings. May advance to elliptical, bike, pool as tolerated.

Exercises: Advance functional activity. Return to sport-specific activity and impact when cleared by MD after 8mo