Autologous Chondrocyte Implantation (ACI) Protocol

The details of the surgical procedure including intraoperative picture are shown here.

Downloadable Carticel  Rehab guide

The postoperative rehab for an ACI procedure is as important as the surgical part of the procedure.  It does no good to go through the cartilage transplantation surgery unless the appropriate restrictions and rehab are closely followed after surgery.  The following is the typical protocol for femoral condyle defects with noted modifications for a trochlea defect surgery.  Please look to Dr. Maffet for any modifications for your particular case.  ROM and weight bearing restrictions are critical to the success of the procedure.

When a cartilage transplantation is performed, new cartilage cells are place din the defect and held the with a carefully placed patch microscopically sewn into place.  These cells need to be protected to prevent displacement.  Then they need to be appropriately stimulated to encourage growth and maturation of the new hyaline cartilage.  This protocol will help do that.


Months 1 and 2


ROM Restrictions –  Passive ROM with CPM only for first 6 weeks.  Try to avoid any active ROM

–   Femoral condyle defects – 0 to 45 degrees weeks 1 – 2, 0 to 90 degrees weeks 2 – 4, 0 to 120 degrees weeks 4 – 8.

–    Trochlear defects –  0 to 30 degrees weeks 1 – 2, 0 to 90 degrees weeks 2 – 4, 0 to 120 degrees weeks 4 – 8.

IROM Brace – needs to be worn at all times lock in full extension.  Off for CPM only.

Strengthing / Stretching – Only quad sets and SLR’s for quad strengthening frequently throughout the day to keep quad engaged.  EMS for quad is good.  Hamstring stretching.  Calf stretching with a towel.  No closed chain quad work.

Gait Restrictions – You’re going to be on crutches for awhile!

–  Femoral condyle defects – NWB for first 6 weeks then PWB next at 6 weeks with the crutches.

–  Trochlear defects – Can PWB right away.  FWB by 4 – 6 weeks.

Cycling can begin at 6 weeks.  Patella mobilization. Ice modalities throughout this first phase.


Month 2 to 4


ROM – Work toward full ROM 0 to 140 degrees.  Prone hangs for full extension.  Sit forwards in chair with planted foot for flexion.  Heel slides.

IROM Brace – Can be discontinued when quad function allows.

Strengthening / Stretching –  Continue quad sets and SLR’s.  Can start early closed chain quad strengthening with Total Gym.  Focus WB on heels. Concentrate on time and reps, not amount of weight. 0 to 60 degrees.  Wall squats.  Leg presses.  Hip strengthening.  Calf raises.  Hamstring stretching.  I don’t like active open chain kinetic quad activities.  Cycling is great.  Can increase the time and intensity during this phase. Continue ice modalities.

Balance / Cardio – Cycling.  Single leg stance. Plyoball toss.  Treadmill walking concentrating on good gait as crutches are DC’ed.  Cone walking. Continue ice modalities.


Month 4 – 6


ROM –  Full.  Continue prone hangs and sit forwards in chair if not.

Strengthening / Stretching – Get full quad tone back.  Continue all 2 to 4 month exercises.  Can work up to step-ups, regular squats, single leg wall squats, increase cycle resistance.  Continue ice modalities.

Balance / Cardio –  Plyoball, squats on balance board, step-ups.  Intensity depends on status of the quads.


Month 6 – 12


Hopefully by now quad muscle strength, size, and tone are back.  Increase intensity of workouts.

Start lateral movements and sports cord in multi-directions.

Jogging first on treadmill.  Start 1 minute jog / 1 minute walk and advance very slowly watching for any swelling.  Continue ice modalities..

Jump rope.