Rehab Knee Trochlear OCD Repair
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

Rehab Knee Trochlear OCD Repair

Trochlear Osteochondral Defect Repair Protocol

Preoperative

Goals:

  • Maximize ROM and progress functional strength
  • Independent post operative HEP
  • Independent in crutch use Non-weight bearing (NWB) including all of patient’s known ambulation barriers (stairs, varied surfaces)

Treatment:

  • ROM, joint mobilization
  • Aquatics exercise program, Therapeutic exercise program
  • Education on HEP to be initiated post operatively
  • Crutch training NWB. Include training for any ambulatory barriers
  • Any modalities needed for symptomatic control

Phase 1

Postoperative Week 0-6

Goal:

  • Full passive knee extension to 120°
  • Full passive knee flexion to 115-120°
  • Minimal pain and swelling
  • Voluntary quadriceps control
  • Ambulating partial weight bearing at 75% by week 3-4.
  • Normalized gait pattern in the pool

Treatment:

  • In brace locked at 0° during weight bearing
    • Sleep in locked brace for 4 weeks
  • Weight bearing
    • Partial Weight Bearing (25% of body weight) immediately
    • 50% by week 2 in brace
    • 75% by week 3-4 in brace
  • CPM to start day 1
    • Day 1 8-12 hours in CPM 0-40° for big lesions (>6cm), 0-60° for smaller lesions
    • Increase 5-10° daily as tolerated.
    • After 3 weeks, decrease CPM use to 6-8 hours daily through week 6
  • Patellar mobilization 4-6 times daily
  • Full passive knee extension immediately
  • Passive knee flexion 2-3 times daily
    • 0-90 by end of post op week 2-3
    • 0-105 at post op week 3-4, 120° by week 6
    • 0-120 by post-op week 6
  • Calf and hamstring stretching
  • Ankle pumps with thera-tubing
  • Quad setting, Glut setting, Hamstring setting
  • Toe-calf raises by week 2 (partial weight)
  • SLR 4 directions (no resistance)
  • Stationary bike when ROM permits (no resistance)
  • Initiate weight shifts by week 2-3
  • At week 4
    • Multi angle leg press isometric
    • Pool program (gait and exercise)
  • Modalities for pain and swelling control
  • Biofeedback and muscle stim as needed
  • gradual return to activities
  • NO PROLONGED STANDING
  • Strong caution with stair climbing

Phase 2

Postoperative Week 6-12

Goal:

  • Full ROM
  • Able to walk 1-2 miles or bike 30 minutes
  • Increased strength
    • Hamstrings within 20% of uninvolved side
    • Quadriceps within 30% of uninvolved side
  • Balance testing within 30% of uninvolved side

Treatment:

  • Brace discontinued by week 6
    • Consider unloading brace
  • Weight Bearing
    • Progress to Weight Bearing As Tolerated
    • Full Weight Bearing by week 6-8
    • Discontinue crutches Week 6-8
  • Gradual increase in ROM
  • Maintain full Passive knee extension
  • Progress knee flexion to 120-135° by week 8
  • Continue patellar mobilizations and soft tissue mobilizations
  • Continue LE stretching program
  • Initiate mini squats 0-45° by week 8
  • Closed kinetic chain exercises (leg press 0-60°) by week 8
  • Toe-calf raises by week 6 (full weight)
  • Open kinetic chain knee extensions
    • No resistance
    • Start 0-30 then progress to deeper angles
  • Exercise bike (gradually increase time)
  • Elliptical week 9-10
  • Treadmill walking week 10-12
  • Stairmaster at week 12
  • Balance a proprioception drills. Progress static to dynamic
  • Initiate front and lateral step ups by week 8-10
  • Initiate front and lateral step ups and wall squats by week 8-10
  • Modalities for pain and swelling control
  • Biofeedback and muscle stim as needed
  • Continue pool
  • Continue slow steady progressions into functional activities
  • Increase standing and walking tolerances

Phase 3

Postoperative Weeks 12-32

Goals:

  • Full ROM without pain
  • Strength within 80-90% of uninvolved side
  • Balance/stability within 75-80% of uninvolved side
  • Functional activities without increase in any symptoms.

Treatment:

  • Full ROM
  • Leg Press 0-60° progressing to 0-90°
  • Bilateral squats 0-60°
  • Unilateral step-ups progressing from 2” to 8”
  • Forward lunges
  • Walking program
  • Open kinetic chain knee extension
    • From 90°to 40° progressing 1# every 2 weeks beginning week 20 if no pain or crepitation.
  • Bicycle, stairmaster, elliptical, treadmill
  • Swimming
  • Return to all functional activities
  • Light running toward end of this phase with MD approval
  • Initiate Home Maintenance Program (week 16-20)
    • Bicycle
    • Progressive walking program
    • Pool program
    • SLR 4 directions
    • Wall squats
    • Front lunges
    • Step ups
    • LE stretching program

Phase 4

Postoperative Week 32-52

Goals:

  • 1. Return to full unrestricted functional activity

Treatment:

  • maintenance program 3-4 times a week
  • Progress resistance to all strengthening exercises
  • Progress to agility and dynamic balance drill
  • Plyometric activity based on patient need
  • Sports specific training
  • Return to sports:
    • Low impact sports routinely around month 6 post op
    • Medium impact sports months 8-9 for small lesions and 9-12 for larger lesions.
    • High impact sports months 12-18