Articular cartilage transplantation to the ankle rehab protocol

• Non weight bearing status for 4 weeks post-op (resting foot on are okay).
• Patients are cleared to drive once they are off all narcotic pain medications and on size of repaired lesion.
• *Must be cleared by MD typically around week 3 or 4.
• Most patients will be in a posterior splint to maintain dorsiflexion and to remind them not to bear weight.
• Depending on the location of the articular cartilage defect and subsequent graft, patients may have active and/or passive range of motion restrictions.
• Regular manual treatment should be conducted to decrease the incidence of fibrosis.
• Light to no resistance stationary cycling is okay at 3 weeks post-op.
• No resisted inversion/eversion machines (isotonic or isokinetic) for 2 months.
• Low impact activities for 4 months post-op.
• Use of the Continuous Passive Motion Device (CPM) for 4-6 hours a day for 4 weeks is imperative.

Week 1

• Nurse visit day 2 to change dressing and review home program.
• Icing and elevation every 2 hours for 15 minute sessions during wake hours.
• CPM (continuous passive motion machine) at home for at least 6 hours every day.

Manual

• Soft tissue treatments to surrounding areas (avoid bandages). Effleurage for edema.

Exercises

• Lower extremity non weight bearing strengthening exercises (i.e. lying, seated, and standing straight leg raise exercises, isometrics, well-leg stationary cycling, upper body conditioning).
• Foot/ankle exercises consisting of intrinsic muscle strengthening (i.e. toe flexion/extension, arch).

Goals

• Decrease pain, edema.
• Gait non weight bearing x 4 weeks.
• Range of motion restrictions per MD (graft location).

Weeks 2 - 4:

• Nurse visit at 14 days for suture removal and check-up.

Manual

• Manual resisted (PNF patterns) of the knee and hip.
• Range of motion, soft tissue treatments, and effleurage for edema.

Exercises

• Non weight bearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne noninvolved limb and arms only).
• AFTER 3 weeks, bilateral cycling with light to no resistance, slow cadence.
• Continue non-weight bearing strengthening exercises, 1 legged planks, side planks, glut exercises.

Goals

• Decrease pain, edema.
• Gait non weight bearing x 4 weeks.
• Range of motion restrictions per MD (graft location).

Weeks 4 - 6

• M.D. visit at 4 weeks post-op, will progress to partial weight bearing and discontinue use of splint. Progression to full weight bearing is dependent on demonstration of good gait mechanics.

Manual

• Continue with soft tissue mobilization. Initiate scar mobilization if incisions closed. Gentle distraction mobilization to talocrural joint and other joint mobilizations as needed for range of motion.

Exercises

• Incorporate functional exercises (i.e. squats, lunges, Shuttle/leg press, calf exercises, step-ups/lateral step-ups).
• Balance/proprioception exercises.
• Progress stationary cycling.
• Slow to rapid walking on treadmill (preferably a low-impact treadmill).
• Pool/deep water workouts after incisions closed with the use of the splint.

Goals

• Gait partial weight bearing to full weight bearing per quality, discharge assistive device as able.
• Range of motion 80% of non-surgical limb.

Weeks 6 - 8

Manual

• Continue with soft tissue, scar mobilization, and distraction mobilization to talocrural joint and other joint mobilizations as needed for range of motion.

Exercises

• Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines).
• Cautiously add lateral training exercises (side-stepping, Theraband resisted side-stepping).
• Progress to road cycling on flat surfaces as tolerated, short distances to start.

Goals

• Full range of motion.
• Full weight bearing, good gait mechanics.

Weeks 8 - 12

• Introduce inversion/eversion exercises with slow increase in resistance.
• Sports test 1 at 12 weeks.
• Low-impact activities until 16 weeks.
• Patients should be pursuing a home program with emphasis on sport/activity-specific training.

Goals

• Complete and pass Sports test 1 at 12 weeks.
• No high impact activities X 1 year unless approved by MD.

Weeks 12+

• Continue with strengthening, endurance, balance, and sport specific training.
• Increase intensity of low impact type cardio- swimming, cycling, elliptical, etc.
• No high impact activities until 1 year unless approved by MD.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.