Cartilage Restoration — Arthroscopy with Osteochondral Allograft (OCA) Implantation

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

NWB x 4 wks; 50% WB wks 4-6; FWB at 6 wks; exception: WBAT at 1-2 wks for patellar/trochlear lesion with brace locked in extension; brace locked at 0° for all WB until 8 wks

Key Restrictions

NWB x 4 wks (WBAT exception for patellar/trochlear lesion with brace locked in extension); CPM 4-8 hrs/day full ROM for 4 wks; brace locked at 0° for all WB until 8 wks; no concentrated CKC until Phase III criteria met; wall slides begin at 6 wks; aquatic therapy at 6 wks; treadmill walking at 8 wks; leg press 1-45° Phase III then progresses to 0-90° eccentrics; OKC knee extension to 40° (pain/crepitus free arc) Phase II; isokinetic and hop testing ≥85% LSI for discharge

Timeline & Phases

Phase I (~6 wks): NWB (WBAT if patellar/trochlear lesion with brace locked), CPM 4-8 hrs/day, quad sets/SLR/heel slides/ankle pumps, FES for trace-poor quad, hamstring/calf stretching, aquatic therapy at 6 wks, stationary bike with sufficient flexion | Phase II (criteria-based, ~6-12 wks): FWB at 6 wks, D/C crutches when criteria met, wall slides 0-45° at 6 wks → mini-squats, 4-way hip, CKC TKE, proprioception/KAT/BAPS, forward step-up, Stairmaster, treadmill at 8 wks, OKC knee extension to 40° pain/crepitus free arc, SLR progressive resistance | Phase III (~12 wks): normal gait/full flex/good quad, leg press 1-45° → 0-90° eccentrics, CKC, pool jogging/wet vest, underwater treadmill/AlterG, step-down program, NeuroCom forward step-down test | Phase IV (~18 wks+): slide board, walk/jog, vertical jump, agility/plyometrics, sport-specific; brace for sport if MD recommends; discharge criteria ≥85% isokinetic + hop test LSI

Notes

Similar structure to microfracture protocol (307013) but CPM 4-8 hrs/day (vs 8 hrs for microfracture); OKC extension to 40° allowed in Phase II within pain/crepitus free arc; underwater treadmill/AlterG in Phase III; NeuroCom forward step-down test for Phase III assessment; isokinetic and hop testing ≥85% LSI required for discharge; brace for sport activity if MD recommends to unload injured compartment; patellar/trochlear lesion exception: WBAT 1-2 wks with brace locked; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD