Discharge Instructions & Physical Therapy Protocol for Knee Osteochoncra l Autograft

Recovery after knee surgery entails controlling swelling and discomfort, healing, return of range-of-motion of the knee joint, regaining strength in the muscles around the knee joint, and a gradual return to activities.  The following instructions are intended as a guide to help you achieve these individual goals and recover as quickly as possible after your knee surgery.

Comfort

• Elevation - Elevate your knee and ankle above the level of your heart.  The best position is lying down with two pillows lengthwise under your entire leg.  This should be done for the first several days after surgery
• Swelling - A cooling device may be provided to control swelling and discomfort by slowing the circulation in your knee.  Initially, this can be used continuously for the first 3 days, (while the initial post-op dressing is on). After 3 days, the cooling device should be applied 3 times a day for 10-minute intervals. If a cooling device is not provided at the time of surgery, place crushed ice in a plastic bag over your knee for no more than 20 minutes, three (3) times a day
• Pain Medication - Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication
• Antibiotic Medication - If an antibiotic has been prescribed, start taking the day of your surgery. The first dose should be around dinnertime. Continue taking until the prescription is finished
• Driving - Driving is NOT permitted for six weeks following right knee surgery

Activities

• Range-of-Motion - Move your knee through range of motion as tolerated. This must be done while sitting or lying down
• Locking Knee Brace - The brace is to be worn for up to 4-6 weeks following surgery. It will be locked straight until bone healing and good knee strength have been achieved, (usually 6 weeks after surgery). At that time your doctor will determine if your leg has enough strength to allow your brace to be unlocked. You may unlock the brace while sitting but lock the brace before standing. Sleep with the brace on until directed by Dr. Forsythe
• Exercises - These help prevent complications such as blood clotting in your legs.  Point and flex your foot and wiggle your toes. Thigh muscle tightening exercises should begin the day of surgery and should be done for 10 to 15 minutes, 3 times a day, for the first few weeks after surgery
• CPM - (Continuous Passive Motion Machine) - A Continuous Passive Motion (CPM) machine should be started the day after your surgery. This machine will be set at 30°. Motion on the machine should be increased at 10-15° per day or as much as tolerated, to a maximum of 110° in one week. The machine should be used 6 hours per day (i.e. 2 hours in the morning, 2 hours in the afternoon and 2 hours in the evening). Use of the machine will continue for 1-2 weeks, or until maximum flexion of the machine is reached (110°). DO NOT WEAR LEG BRACE OR COOLING DEVICE WHILE USING CPM MACHINE
• Weightbearing Status - You are NOT allowed to put any weight on your operative leg. Walk using two crutches and your knee brace in the locked straight position. You may rest the foot of your operated leg on the floor for balance when standing without putting your weight on it. Your Physical Therapist will instruct you on how and when to progress your weightbearing. Two crutches should be used until directed to discontinue by Dr. Forsythe (approximately 6 weeks)
• Physical Therapy - PT should be started 3-5 days after surgery. You should call the physical therapist of your choice for an appointment as soon as possible after surgery. A prescription for physical therapy, along with physical therapy instructions (included in this packet) must be taken to the therapist at your first visit
• Athletic Activities - Athletic activities, such as swimming, bicycling, jogging, running and stop-and-go sports, should be avoided until allowed by your doctor
• Return to Work - Return to work as soon as possible.  Your ability to work depends on a number of factors - your level of discomfort and how much demand your job puts on your knees.  If you have any questions, please call your doctor

Wound Care

• Tub bathing, swimming, and soaking of the knee should be avoided until allowed by your doctor - Usually 2-3 weeks after your surgery. Keep the dressing on, clean and dry for the first 3 days after surgery
• Remove the dressing 3 days after surgery. The steri-strips (small white tape that is directly on the incision areas) should be left on until the first office visit. You may apply band-aids to the small incisions around your knee
• You may shower 5 days after surgery with band-aids on. Apply new band-aids after showering

Eating

• Your first few meals, after surgery, should include light, easily digestible foods and plenty of liquids, since some people experience slight nausea as a temporary reaction to anesthesia.

Call your physician if

• Pain in your knee persists or worsens in the first few days after surgery
• Excessive redness or drainage of cloudy or bloody material from the wounds (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor
• You have a temperature elevation greater than 101°
• You have pain, swelling or redness in your calf
• You have numbness or weakness in your leg or foot

Return to the office

• Your first return to our office should be within the first 1-2 weeks after your surgery.  Call Dr. Forsythe’s office to make an appointment for this first post-operative visit

COR™ Rehabilitation Protocol for Osteochondral Grafting

0 - 2 WEEKS

• Weightbearing Status: Non-weightbearing using 2 crutches
• Range-of-Motion and Stretching Exercises
  • Passive knee flexion and knee extension range-of-motion
  • Wall slides or heel slides to increase knee flexion range-of-motion
  • Wall slides and passive knee extension with heel supported to increase extension range-of-motion
  • Stationary bicycle with minimum resistance, if range-of-motion allows
• Mobilization: Patellar mobilization, as needed
• Stretching Exercises: Hamstring, iliotibial band, and calf stretches, as needed
• Strengthening Exercises
  • Isometric quadriceps sets
  • Isometric hamstring sets at 70-90° of knee flexion
  • Straight leg raises
  • Hip adduction
  • Ankle plantar flexion with tubing resistance

2 - 4 WEEKS

• Weightbearing Status: Partial weightbearing
  • 2 - 3 weeks - 25% body weight
  • 3 - 4 weeks - 50% body weight
• Range-of-Motion and Stretching Exercises
  • Continue knee extension range-of-motion exercises, as needed
  • Discontinue wall slides at 115-120° flexion, progressing to heel slides
• Strengthening Exercises
  • Progress with strengthening exercises as above
  • Active knee extension
  • Hamstring curls
  • Seated toe raises with resistance
  • Pool exercises, if available
  • Gradually increase resistance on stationary bicycle

4 - 6 WEEKS

• Weightbearing Status: Partial weightbearing
  • 4 - 5 weeks - 75% body weight
  • 5 - 6 weeks - 100% body weight
• Range-of-Motion and Stretching Exercises
  • Continue above exercises, as needed
  • Full knee flexion and extension range-of-motion by 4 - 6 weeks post surgery
• Strengthening Exercises
  • Progress with strengthening exercises, as above
  • Hip abduction, added during the 4th to 5th week, if fair quadriceps contraction is present

6 - 8 WEEKS

• Weightbearing Status: Progress to full weightbearing, without assistive device, by 6 weeks post surgery
• Strengthening Exercises
  • Closed kinetic chain
    • Standing toe raises
    • Partial squats
    • Leg press exercise
    • Step exercises: step-down, step-up, lateral stepping
  • Open kinetic chain: Isokinetic training: 200+ speed

8 - 10 WEEKS

• Brace : Discontinue knee brace if SLR without lag and exhibits non-antalgic gait pattern
• Functional Exercises
  • Treadmill walking, progressing to an uphill grade of 2-3%
  • Stepper machine (i.e., Stairmaster, Climbmax)

10 - 12 WEEKS

• Strengthening/Functional Exercises: Mini-trampoline jogging, as tolerated