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.

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

MILESTONES TO WORK TOWARDS

• 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

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

• 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

MILESTONES TO WORK TOWARDS

• 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.

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

MILESTONES TO WORK TOWARDS

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

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

• Gradual return to full functional activities as
  progression in rehabilitation and cartilage
  healing allows.
  

MILESTONES TO WORK TOWARDS

• 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