CARTICEL Rehabilitation guidelines

Phase I: Protection (weeks 0-6)
During this first phase, CARTICEL
begins to fill the injured area with
a soft repair tissue and it is critical
that the area be protected.

Phase II: Transition (weeks 6-12)
The repair tissue is spongy and remains
fairly soft at this point, so protection is still
required. Towards the end of the phase, as
tissue continues to mature, patients typically
are able to bear full weight on their knee and
resume most daily activities.

GOALS

• Protect healing tissue from
  movement and weight
• Decrease pain and swelling
• Gradually improve knee’s ability to flex
  and extend
• Regain quadriceps control

Example Rehabilitation Activity
Continuous Passive Motion (CPM),
8-12 hours/day, from day 1

Example Functional Activity

• Body weight should not be placed on the knee
• for about 1 week following implantation
• Use of crutches
• Extended standing should be avoided
• Gradual return to daily activities as pain
• and inflammation allow
• Use of stationary bicycle as range of
• motion (ROM) allows
• May begin pool exercises by week 4

GOALS

• Obtain full ROM
• Further improve strength and endurance
  of quadriceps and hamstrings
• Increase endurance of functional activities

Example Rehabilitation Activity
If leg is braced, discontinue by week 6

• Initiate exercises such as weight shifts,
• mini squats and toe-calf raises
• Perform balance drills for leg strengthening
• Gradually increase time with stationary bicycle
• at low resistance
• Initiate treadmill walking program

Example Functional Activity

• Increase the amount of body weight you
  place on your knee as tolerated
• Place full body weight on your knee and
  discontinue crutches by weeks 6-9
• Increase the duration of functional activities
  such as standing and walking as pain and
  swelling diminish

Phase III: Maturation (weeks 12-26)
As the repair tissue becomes firmer
and has a hardness like soft plastic, your patient
will be able to perform more functional
and training activities. You patient will notice
improvements of symptoms and generally
normal motion of the knee.

Phase IV: Active (months 6-18)
During the final phase of your patient's
rehabilitation, the repair tissue reaches
full maturity and its firmness resembles
that of the surrounding cartilage.

GOALS

• Improve muscular strength and endurance
• Improve balance and stability
• Achieve full ROM and functional activities by
  the end of this phase with minimal or no pain
  and swelling

Example Rehabilitation Activity

• Strength exercises including leg press,
  forward lunges, straight leg raises and hip
  abduction/adduction
• Stretch quadriceps, hamstrings and calves

Example Functional Activity

• Bicycle
• Stair machine
• Swimming and pool exercises
• Ski machine/elliptical trainer
• Increase walking in terms of distance,
  cadence, incline, etc., as tolerated

GOALS

• Gradual return to full unrestricted
  functional activities

Example Functional Activity

• Return to low-impact sports such as
  swimming, skating, in-line skating and
  cycling at month 6
• Return to higher-impact sports such
  as jogging, running and aerobics at
  months 8-9 for small lesions or
  months 9-12 for larger lesions
• Return to high-impact sports such
  as tennis, basketball, football and
  baseball at months 12-18