Tibiofemoral Cartilage Restoration

Physical Therapy Protocol

Phase I – Protection & Mobility (Post-Op Weeks 1–3)

Goals:

• Protect the surgical site.
• Control inflammation and pain.
• Begin early controlled motion within set limitations.

Precautions:

• Use TROM brace:
  • Week 1: 0–30°
  • Weeks 2–3: 0–45°
• Weight Bearing:
  • Week 1: 20% body weight
  • Increase by 10% each week
  • Full weight bearing by Week 8

Exercises:

• Isometric quadriceps sets
• Straight Leg Raises (SLR)
• Open Kinetic Chain (OKC) strengthening within ROM limits

Phase II – Strength (Post-Op Weeks 4–6)

Goals:

• Improve lower extremity strength.
• Normalize early muscle activation patterns.

Activities:

• Gait training with progressive weight-bearing
• Weight shifting activities
• Emphasis on glute strength and VMO (vastus medialis oblique) control
• Use stationary bike (no resistance) to promote ROM

Phase III – Gait Normalization (Post-Op Weeks 7–12)

Goals:

• Achieve full weight bearing.
• Normalize gait pattern and eliminate compensations (e.g., Trendelenburg gait).

Exercises:

• Advanced gait training
• Bodyweight squats (as tolerated)
• Begin elliptical (low resistance)

Phase IV – Proprioceptive Phase (Post-Op Weeks 13–24)

Goals:

• Enhance joint stability.
• Improve neuromuscular control.

Activities:

• Progress to closed kinetic chain (CKC) exercises
• Advance from double-leg to single-leg strengthening and balance drills
• Increase dynamic proprioceptive training

Phase V – Functional Return (Post-Op Month 6 and Beyond)

Goals:

• Safely return to sport and high-level functional activities.

Activities:

• Initiate structured return-to-running program
• Begin sport-specific drills (e.g., cutting, jumping, agility drills)
• Continue progressive strengthening and balance training