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Mosaicplasty and OATS Rehabilitation Protocol

PHASE 1: 0 – 2 weeks after surgery
 
You will go home with crutches, cryocuff cold therapy unit and a CPM machine.
 
GOALS:
1. Protect the cartilage transfer – avoid weight bearing if instructed to do so
2. Ensure wound healing
3. Attain and maintain full knee extension
4. Gain knee flexion (knee bending) to 90 degrees
5. Decrease knee and leg swelling
6. Promote quadriceps muscle strength
7. Avoid blood pooling in the leg veins
 
ACTIVITIES:
 
CONTINUOUS PASSIVE MOTION (CPM)
Use the CPM machine at home as much as possible. Do not wear the brace when in the CPM machine.You should use the machine at least 10 hours per day.  You may move the machine to a sofa, the floor or onto a bed as you change positions and locations. You should use the machine at night while sleeping; slow down the machine at night to facilitate sleeping.  Extension (knee straight) on the machine should be set at minus five degrees at all times to help your knee extend.  It is very important that you straighten the knee completely!  The machine should be programmed to include an extension pause of 5 seconds (in other words, when the knee is straightened out, it pauses in the straight position to allow you to stretch it out straight).  This flexion setting will start at around 30 – 40 degrees and should be gradually increased to 90 degrees as you can tolerate more bending of your knee.
 
BRACE/CRUTCHES
For patellar and trochlear groove lesions, you will wear a knee brace, which is set to allow your knee to bend only 30 degrees and straighten fully.  Use it when walking and put as much weight on your operated leg as possible (without pain) when walking.  You should use the crutches in the beginning, but can discontinue the crutches when you have confidence in the knee to support you.
 
For femoral condyle defects, no brace is used, but crutches and restricted weight bearing will be necessary for longer periods.  Your doctor will give special instructions in these cases.
 
CRYOCUFF (COLD APPLICATION)
If you are experiencing pain, swelling, or discomfort, we suggest icing for 15-20 minutes with at least a 60-minute break in between. Use your cryocuff or place ice in a zip lock bag and/or in a towel and apply to the injured area. Never place ice directly on the skin.
 
WOUND CARE
Remove your bandage on the second morning after surgery but leave the small pieces of white tape (steri strips) across the incision.  You can wrap an elastic bandage (ace) around the knee at other times to control swelling.  You may now shower and get your incision wet, but do not soak the incision in a bathtub or Jacuzzi until the stitches have been removed.
 
ASPIRIN / ELASTIC STOCKINGS
Take an aspirin each morning, wear an elastic stocking (TED) below the knee, and do at least 10 ankle pump exercises each hour to help prevent phlebitis (blood clots in the veins).
 
FREE / MACHINE WEIGHTS
Upper Body/Trunk Only
We suggest that you do not use any lower extremity free or machine weights. If you are doing free or machine weights for the upper body and trunk, we suggest a very light resistance of 3 sets of 15-20 repetitions. Do not place yourself in a compromising position with your recently operated knee.
 
EXERCISE PROGRAM
 
QUADRICEPS SETTING - to maintain muscle tone in the thigh muscles and straighten the knee.                                                              
Lie on your back with the knee extended fully straight as in figure.  Tighten and hold the front thigh muscle making the knee flat and straight.  If done correctly, the kneecap will slide slightly upward toward the thigh muscle.  The tightening action of the quadriceps should make your knee straighten and be pushed flat against the bed or floor. Hold 5 seconds for each contraction.  Do 20 repetitions three times a day.
 
HEEL PROP- to straighten (extend) the knee.
Lie on your back with a rolled up towel under your heel or sit in a chair with the heel on a stool as shown in the figure.  Let the knee relax into extension (straight).  If the knee will not straighten fully, you can place a weight (2 to 5 pounds) on the thigh, just above the kneecap.  Try to hold this position for 5 minutes, three times a day. While maintaining this extended position, practice quadriceps setting.
 
HEEL SLIDES - to regain the bend (flexion) of the knee.
While lying on your back, actively slide your heel backward to bend the knee.  Keep bending the knee until you feel a stretch in the front of the knee.  Hold this bent position for 5 seconds and then slowly relieve the stretch and straighten the knee.  While the knee is straight, you may repeat the quadriceps setting exercise. Repeat 20 times, three times a day.
 
SITTING HEEL SLIDES  - to regain the bend (flexion of the knee).
When sitting in a chair, slide the heel backward as if trying to get the foot underneath the chair (figure 5).  Hold 5 seconds and slowly relieve the stretch by sliding the foot forward. You can help with the opposite foot if necessary. Repeat 20 times, three times a day.
 
ANKLE PUMPS - to stimulate circulation in the leg.You should do at least 10 ankle pump exercises each hour.
 
OFFICE VISIT
Please return to see Dr. Gill approximately ten to fourteen days after your surgery.  At this time, your sutures will be removed and your progress will be checked.

 

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