Fixation of Osteochondral Defect of Knee Rehabilitation Protocol with No Other Procedures

Restrictions:

  • 6 weeks range of motion limitation 0 - 30 degrees.  

  • Use of Zimmer splint or locked ROM brace

  • 6 weeks onwards start gradual increase in range to full flexion

  • No weight bearing in more than 90 degrees flexion for 12 weeks

  • No weight bearing for the first 6 weeks when walking – use of crutches

  • Gradual increase in loading avoiding limited by pain and swelling after 6 weeks

  • Avoid cycling for the first 6 weeks post-operative

  • Light jogging on a treadmill from week 12 onwards

o   Must have

-  Full range of motion and quadriceps control.

-  Walking for 30 minutes pain and swelling free

  • Avoid pivoting and contact sports for 4 months

 

Patients should:

  • Have a grasp of exercises and use of crutches and simple ADL functions prior to discharge home

  • Do exercises 3 - 6 x per day

 

At 2 and 8 week follow up

  • Wound review

  • Check pain levels

  • Observe gait and simple ADLs

 

Phase 1: Post-operative Day 1 to discharge

Goal

Swelling and pain management and safe mobility

Action

  • Cryotherapy may begin once sensation has returned to normal

    o   20 minutes

  • Circulation exercises for the foot and ankle

  • Gait training with crutches in splint

Criteria to move to next phase includes

  • Safe mobility

  • Pain and swelling well controlled

  • Able to mobilise with crutches non weight bearing on repaired side

 

Phase 2 : Discharge to 6 weeks post-operatively

Goal

Continue with baseline exercises, swelling management, quadriceps activation.

Action

  • Continue ankle exercises

  • Continue quadriceps activation exercises

Criteria to move to next phase includes

  • Swelling and pain well controlled

  • Able to perform the basic exercise regime daily with limited pain and swelling

Phase 3: From 6 - 12 weeks post-operatively

Goals

To achieve comfortable range of motion, control of quadriceps activity, begin partial weight bearing and weaning from crutches

Action

  • Daily active exercises. Continue quadriceps activation exercises. Active and passive knee flexion and extension

  • Lower limb general strengthening regime

  • Begin range of motion exercises with graded increase

  • Increase quadriceps activity with light loaded closed chain exercises

  • Avoid loading in more than 90 degrees

  • May begin cycling unloaded

Criteria to move to the next phase

  • Near non tender, near pain free for all movements, achieve full range of motion without apprehension of dislocation.

Phase 4: From 12 weeks onwards

Goals

Increase range of motion (free range of motion within pain limits), Increase quadriceps activation, balance and proprioception control.

Action

  • Passive and active assisted scapular range of motion exercises for flexion, abduction, internal and external rotation – focus on good quality motion

  • Increase strength in graded manner moving to concentric and eccentric training.

  • Balance training

  • Proprioception training

Criteria to move to the next phase

  • Minimal swelling and pain associated with exercise.

  • Achieving good range of motion with little apprehension of dislocation

Phase 5: From week 16 onwards

Goals

Return to and normalise activities of daily living including sporting activities.

Action

  • Increase strength training loading as tolerated

  • Strength for lower limb musculature

  • Aim for continued normal active and passive range of motion

  • Functional training for ADLs and sporting activity

  • No running prior to week 16 post operatively

o   Criteria to run include

-  Walking and cycling 30 minutes without pain and swelling

-  Strength and balance to 90% of contralateral limb

-  Full range of motion

  •  No pivoting or contact sports for 6 months post op