Cartilage Restoration — MACI (Matrix-Induced Autologous Chondrocyte Implantation) — Tibiofemoral Joint

Mammoth Orthopedic Institute / Sierra Park PT · Brian B. Gilmer MD (US Ski Team Physician); Karly M. Dawson PA-C

Weight-Bearing

TTWB x0-4 weeks; 25% WB progression/week to 50% PWB by 6 weeks (may change if bipolar lesions); FWB weaning from crutches/brace at 6-12 weeks

Key Restrictions

Brace locked in extension for gait, unlocked for NWB ROM x6 weeks; ROM slow progression (0-30° wks 0-2, 30-90° wks 2-3, 90-130° wks 4-6); no OKC quad strength x6 weeks; CPM day 1 set 0-30°; no impact (running/jumping) x12 weeks; no cutting/pivoting/heavy impact x6 months; no running on uneven surfaces x9 months; RTS at 9 months

Timeline & Phases

3 phases: Phase I (0-6 wks, TTWB x4 wks then 25% WB/wk to 50% by wk 6, CPM day 1, ROM progression 0-130°), Phase II (6-12 wks, FWB, CKC double to single leg, balance/proprioception), Phase III (3-6 months, agility, single leg progression, running on controlled surfaces)

Notes

References MACI Rehabilitation Manual by Jay Ebert PhD AEP ESSAM (University of Western Australia); tibiofemoral lesion — TTWB x4 weeks (longer NWB than PF variant which is TTWB x1 week); ROM progression also slightly slower in early weeks; RTS at 9 months; walk pain-free >3 miles all terrain for RTS

Surgeon / Author

Brian B. Gilmer MD (US Ski Team Physician); Karly M. Dawson PA-C