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 Osteochondral Graft Transplant Surgical Rehabilitation (OATS)

Phase I (0 - 6 weeks)


  • Home exercise program will begin after surgery

  • 2-3xwk or as designated by rehabilitation specialist

Rehabilitation Goals

  • Protection of healing tissue from load and shear forces

  • Decrease pain and effusion

  • Restoration of full passive knee extension

  • Gradual improvement of normal knee flexion

  • Regaining quadriceps control and patella mobility

Brace/Weight bearing

  • Locked in extension

  • Sleep in locked brace

  • Non-weight bearing

Suggested Therapeutic Exercise

  • Immediate motion exercises, full passive knee extension

  • CPM 4-6 hours per day 0-40 degrees, increase by 5-10 degrees

    per day as tolerated

  • Range of motion goals: 90 degrees by 2 weeks and 115 by four

    weeks and 125 by six weeks

  • Patellar and soft tissue mobilization

  • Hamstring, calf, and quadriceps stretching

  • Ankle pumps, quad sets, multi-angle isometrics, active knee

    extension 90-40 degrees, SLR 4 directions, stationary bike, biofeedback and EMS,

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

• Progress two weeks post-operatively


Phase II (6-12 weeks)


  • Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

  • Gradually increase ROM and WB to full

  • Gradually improve quadriceps strength/endurance

Brace/Weight Bearing Status

  • Discontinue use of brace

  • Progress weight bearing as tolerated by increasing 25%/week

    until full WB

• Discontinue crutches at 12 weeks

Suggested Therapeutic Exercise

  • Range of motion: 125-135 degrees

  • Continue patellar mobilization and soft tissue mobilization as


  • Continue stretching program

  • Week 6: initiate weight shifts

  • Week 8: Initiate mini-squats 0-45 degrees, closed chain


  • Week 10: toe-calf raises, open kinetic chain knee extension,

    stationary bike, balance and proprioception, front and lateral step ups, continue biofeedback and EMS,

Cardiovascular exercise

• Upper body circuit training or UBE, bike as range of motion allows

Progression Criteria

  • Full range of motion

  • Acceptable strength level, quadriceps within 15% of

    contralateral leg and hamstrings within 10% of contralateral

  • Balance testing within 30% and single leg balance >15 seconds

  • Able to bike for 30 minutes


Phase III (3-6 months post-operatively)


  • Rehabilitation appointments are once every 1-2 weeks

Rehabilitation Goals

  • Improve muscular strength and endurance

  • Increase functional activities


  • Avoid post-activity swelling

  • Post activity soreness should resolve after 24 hours

  • Avoid pain with knee strengthening activities

Suggested Therapeutic exercises

  • Range of motion: no restrictions – obtain full motion

  • Leg press 0-90 degrees, Bilateral squats 0-60 degrees

  • Unilateral step-ups progressing from 2-8”step

  • Forward lunges

  • Walking on treadmill

  • Open kinetic chain extension 0-90 degrees

Cardiovascular exercise

• Upper body circuit training or UBE, non-impact lower body exercises including bike, elliptical, swimming, stair climber

Progression criteria

  • Full non painful ROM

  • Strength within 90%

  • Balance and/or stability within 75%

  • No pain, inflammation or swelling


Phase IV (6 months post-operative)


Rehabilitation appointments are once every week

Rehabilitation Goals

Proprioceptive and muscular control with work and sport specific activities


  • Post activity soreness should resolve in 24 hours

  • Avoid post activity swelling

  • Avoid knee pain with higher impact activities

Suggested Therapeutic exercises

  • Continue maintenance program progression 3-4x/wk.

  • Progress resistance as tolerated

  • Emphasis on entire lower extremity with strength and


  • Progress agility and balance drills

  • Impact loading program should be specialized to the patient’s


  • Progress sport/work program

Cardiovascular exercise

• Replicate sport/work

Return to sport/work criteria

• Patient may return to various sport activities as progression in rehabilitation and cartilage healing allows. Generally, low impact sports such as skating, rollerblading, and cycling are permitted at about 8 months. Higher impact sports such as jogging, running, and aerobics may be performed at 8-10 months. High impact sports such as tennis, basketball, soccer and baseball are allowed at 10-12 months.

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