Osteochondral Allograft Rehabilitation Protocol

Download Now

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.