Cartilage Restoration — MACI (Matrix-Induced Autologous Chondrocyte Implantation) — Official Rehabilitation Manual

Vericel Corporation · Jay Ebert PhD AEP ESSAM (Hollywood Functional Rehabilitation Clinic /…

Weight-Bearing

≤20% BW wk 1 (TF) / <20% BW wk 1 (PF); graduated to full WB by wks 8-10 (TF) / wks 4-6 (PF); 2 crutches wks 1-5, 1 crutch wks 6-7, crutch as required wks 8-10, none from Phase V

Key Restrictions

No brace removal without surgeon approval; no shear forces on graft; no active knee extension against resistance Phase I; no flexion >30° Phase I; ROM restricted: TF 0-30° wk 1 → 90° by wk 3 → 125° by wk 6; PF 0-20° wk 1 → 60° by wk 3 → 125° by wk 6; brace TF 0-30° initially; PF brace locked full extension throughout early phases; no high-impact activities until 12-18 months; high compression/shear/rotational loads avoided until 12-18 months; no OKC knee extension until Phase V; leg press ≤50% BW through 60-90° flexion in Phase V

Timeline & Phases

Phase I (wk 1): partial WB ≤20% BW (TF) / <20% BW (PF), CPM 0-30° starting 12-24 hrs post-op min 1 hr/day, ROM 0-30° (TF) / 0-20° (PF), 2 crutches, isometrics, ankle pumps | Phase II (wks 2-3): WB 20-30% → 30% (TF) / 20-50% (PF), ROM to 90° by wk 3 (TF) / 60° by wk 3 (PF), SLR, deep-water hydrotherapy, CPM continued | Phase III (wks 4-6): WB 40-60% (TF) / 75%-full (PF), ROM to 125° (TF/PF), recumbent cycling wks 5-6, shallow water exercises, brace to 0-60° then full flexion (TF) | Phase IV (wks 7-12): full WB TF wks 8-10 / PF already full, full active ROM, upright cycling wks 9-12, proprioception, single leg squats ~wk 12, 6-min walk test goal pain-free without aids by wk 12 | Phase V (3-6 months): full WB, no brace/crutches, modified OKC/CKC, leg press ≤50% BW 60-90° flexion, rowing ergometry, return to work | Phase VI (6-9 months): low-impact recreational activities, mini-trampoline jogging, step ups/downs, hamstring/calf 80-90% contralateral limb | Phase VII (9-12 months): running program (walk/jog/run on soft surface), agility drills, lunges/squats on unstable surfaces; RTS competitive after 12 months

Notes

Official Vericel manufacturer rehabilitation manual; two implant site variants with different timelines throughout (TF: tibiofemoral vs PF: patellofemoral); CPM started 12-24 hrs post-op min 1 hr/day; hydrotherapy used extensively Phases I-IV; Phase I contraindications: >20% BW, no brace, shear forces, flexion >30°, active knee extension against resistance; high compression/shear/rotational loads avoided until 12-18 months; RTS competitive after 12 months; written by Jay Ebert PhD based on Ebert et al. clinical research; electronic scales recommended for training partial WB accuracy; referenced from Kremen MD (UCLA) PatientPop practice site

Surgeon / Author

Jay Ebert PhD AEP ESSAM (Hollywood Functional Rehabilitation Clinic / University of Western Australia)

Published

December 2016