allograft transplant knee

The procedure may need to be postponed. endobj The new meniscus is sewn in place and requires postoperative protection to allow healing. /Pages 31 0 R Cotter et al. 0000009859 00000 n Found inside – Page 641Osteochondral autograft transplantation is used to address small to medium defects ... areas of the knee joint and press-fitted into the prepared defect. This includes medicines, supplements, or herbs you bought without a prescription. A dressing is placed over the wound. 0000001067 00000 n 0000004698 00000 n << /Filter /FlateDecode /Length 258 /Subtype /Type1C >> Sometimes the meniscus can be sewn into place without the use of the bone plugs or bridge. /O 34 However, it has take several years for the procedure to gradually gain… It can take from a few weeks to a few months. << Over time, this can lead to progressive degenerative changes and osteoarthritis.… If you smoke, try to stop. Osteochondral Autograft Transplant Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Pain is usually managed with medicines. Though they may vary from one patient to the next, here’s a summary of what those phases may look like: For those who meet the criteria for meniscus transplantation and are able to fully engage with the rehabilitation program, the outlook is good. Found inside – Page 554Survival and reoperation rates after meniscal allograft transplantation: analysis of failures for 172 consecutive transplants at a minimum ... Learn more about A.D.A.M. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Found inside – Page 404During surgery, care must be taken to avoid nerve damage to the superficial ... ankle arthrodesis may be the only option before below-the-knee amputation is ... Found inside – Page 42433.4.1 Meniscal Allograft Transplantation (MAT) The aims of a meniscal replacement are to diminish pain ... and to improve the stability of the knee joint. following transplantation. 0000006643 00000 n 0000002652 00000 n To use the sharing features on this page, please enable JavaScript. /ProcSet [ /PDF /Text ] /Rotate 0 The cartilage cells can survive the transplantation only if the tissue is 'fresh', which means it has not been . Allograft tissue that is not transplanted fresh can be freeze-dried or deep frozen for storage. endobj Found inside – Page 641Osteochondral autograft transplantation is used to address small to medium defects ... areas of the knee joint and press-fitted into the prepared defect. Meniscal allograft transplantation. Allograft is a term that simply means “the transplantation of tissue from one person (a donor) to another.”. A size-matched, fresh-frozen graft is obtained from the tissue bank. Doing so helps prevent stiffness. DeLee, Drez & Miller's Orthopaedic Sports Medicine: Principles and Practice. 1. Typically, a 2- to 4-inch incision is made in the knee with a few other small "poke" holes. In: Miller MD, Thompson SR, eds. Take the medicines your provider told you to take with a small sip of water. /T 70050 Duplication for commercial use must be authorized in writing by ADAM Health Solutions. Font Family. Osteochondral Allograft (OATS/Mosaicplasty) Transplantation of the Knee: Cartilage defect measuring 2.5cm² to 10cm²; Use of fresh osteochondral allograft plugs For tendon allografts, cadaver donors are usually used. The goal of meniscal allograft transplantation is to restore knee function and prevent further joint degeneration by replacing the damaged or destroyed meniscus with allograft tissue having similar properties as the damaged tissue. And sometimes these injuries need special care and attention. 0000004719 00000 n Aging, or engaging in sports . Osteochondral Autograft Transfer and Allograft Transplant (OATS) for the Knee. He or she then inserts a thin tube equipped with a camera and surgical tools into these incisions. Loss of a meniscus tends to lead to arthritis in a knee. But without this critical shock-absorbing component, the articular cartilage that allows bones in the knee joint to glide smoothly against one another wears thin. Indications for this procedure include young active patients with large focal defects, failure of previous cartilage repair, osteonecrosis, osteochondritis dissecans, and/or posttraumatic osteochondral defects. One is on the inside (medial meniscus) and one is on the outside (lateral meniscus). Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament, (MCL), and Lateral Collateral Ligament (LCL): Meniscal allograft transplantation is a type of surgery in which a new meniscus, a cartilage ring in the knee, is placed into your knee. Some people can still have pain after the meniscus is removed. Font Size. 10.1055/b-0034-92487 Osteochondral Allograft Transplantation in the Knee William Bugbee, Marco Cavallo, and Sandro Giannini. Most knee cartilage replacement surgeries are called OATs surgeries—either osteochondral autograft transplantation or osteochondral allograft transplantation surgeries. There is also another less common surgery called autologous chondrocyte implantation. Physical therapy can help you regain the motion and strength of your knee. The new meniscus is taken from a person who has died (cadaver) and donated their tissue. Knee Cartilage Replacement. >> Allograft. Certain complications have been associated with meniscal allograft transplantation including: Around a third of people who undergo a meniscal allograft transplantation will eventually require additional surgery to repair tears or other failures of the transplanted meniscus. It can take 6 months to a year to fully return to activities and sports. 0000003919 00000 n The new meniscus is inserted into your knee and sutured (sewn) in place. This procedure is technically known as a meniscal allograft transplantation. << Are ACL Tears Really More Common in Women? When a meniscus is torn, it is commonly removed by knee arthroscopy. Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. A bone graft is a surgical procedure used to fix problems with bones or joints. The anterior and posterior horns are marked, and 8-mm bone blocks are grossly created with an oscillating saw. Campbell's Operative Orthopaedics. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the different potential definitions of 'success' and 'failure'. Knee Surg Sports Traumatol Arthrosc, 23:323-333. 0000002002 00000 n 1,2 The surgical technique for meniscal allograft transplantation of the knee continues to evolve. 3,14 Importantly, if these lesions are not addressed in a timely The outcome should dictate the surgical . The new meniscus is taken from a person who has died (cadaver). H�bd`ab`dd�q��su���M,�H�M,�LN� �� �(JMɛ��g�!��C���q��. Other names that refer to a type of knee cartilage transplant include: Meniscal allograft transplantation is the procedure of surgically implanting a new meniscus, which is provided by a donor, into someone's knee. 0000007365 00000 n The new meniscus can help with knee pain and possibly prevent future arthritis. Studies suggest that up to 80 or 90% of athletes are able to return to pre-injury sporting activities following meniscal transplantation. << 0000003178 00000 n Like any surgery, complications can occur. Found inside – Page 511Prognostic Factors for Arthroscopic Debridement of Osteoarthritic Knee From ... osteochondral allograft transplant (78%); however, only 30% of knees with ... Found inside – Page 37Chahal and colleagues51 conducted a systematic review of clinical outcomes after osteochondral allograft transplantation in the knee and reviewed more than ... Other parts of the patient’s knee may also require treatment. Knee. Allograft ing or, to give its full name, 'fresh osteochondral allograft transplantation (OCA)' is an operation in which a damaged or diseased area of a joint is reconstructed using a bone and cartilage transplant. Clinical outcomes of osteochondral allograft transplantation for secondary treatment of osteochondritis dissecans of the knee in skeletally mature patients. "Our findings note that patients older than 40 may benefit from using a fresh osteochondral allograft transplantation to treat focal cartilage defects, a common cause of knee pain . Dr Prodromos is a specialized knee surgeon at Illinois Sports Medicine and Orthopaedic Centers and performs osteochondral allograft transplant to repair the cartilage damage. A meniscus is a crescent-shaped wedge of cartilage located on the proximal articulating surface of the tibia within the Two-year follow-up of bone mineral density changes in the knee after meniscal allograft transplantation: results of an explorative study. Tell your surgeon if you develop a cold, flu, fever, herpes breakout, or other illness before your surgery. These treatments keep as much healthy meniscus tissue (and its shock-absorbing capacity) intact as possible. Therefore, crutches and brace are continued for 6 weeks. Meniscus allograft transplantation is a difficult surgery, and the recovery is hard. The new meniscus is taken from a person who has died (cadaver) and donated their tissue. To attach it, the surgeon may need to drill tiny holes into the end of the patient’s shinbone. The defect may be identified by MRI and/or arthroscopy. Screws or other devices may be used to hold the meniscus in place. Complications after a meniscus transplant are rare, but the risk of complications is never zero. Allograft meniscus replacement can be safely performed under general or spinal anesthetic. endobj You will likely be able to move the knee right after surgery. /TrimBox [ 9 9 594 792 ] A.D.A.M. Recovery from a meniscus transplant. It also can be successfully used to correct a previously failed . /Font << /F1 39 0 R /F2 40 0 R /F3 41 0 R /F4 42 0 R /F5 57 0 R /F7 49 0 R >> Ruzbarsky JJ, Maak TG, Rodeo SA. Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque. Found inside – Page 451Wirth et al. reported the first series of anterior cruciate ligament reconstructions with concomitant meniscal allograft transplantation and noted Lysholm ... All-in-one graft prep station and tibial drilling system. Found inside – Page 17Bugbee W, Cavallo M, Giannini S. Osteochondral allograft transplantation in the knee. J Knee Surg. 2012;25(2):109–16. O'Driscoll SW, Keeley FW, Salter RB. The new meniscal tissue is anchored into the shinbone to stabilize the transplant. During arthroscopy, most surgeons take pictures of the procedure from the video monitor to show you what was found and what was done. What is an Osteochondral Autograft Transfer? Meniscal allograft transplantation. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. is also a founding member of Hi-Ethics. Ask your provider which medicines you should still take on the day of your surgery. Found inside – Page 2886. Kang RW, Lattermann C, Cole BJ. Allograft meniscus transplantation: background, indications, techniques, and outcomes. J Knee Surg 2006;19:220–230. 7. I. Allograft Transplant of the Knee Aetna considers allograft transplant of the knee (knee ligaments, osteochondral, and meniscus) medically necessary when selection criteria are met. Meniscus allograft replacement surgery is a minimally invasive method to restore previously removed torn knee cartilage with cadaver tissue. By transplanting allograft cartilage onto deteriorated cartilage, a patient's deteriorating knee joint can be preserved. The front and back tips of the “c”-shaped donor meniscus may be attached to small plugs of bone or to a tiny bridge of bone. Allograft is routinely used to fill the space created from correcting the mechanical axis since autografts add extra time to the procedure and donor site morbidity to the patient. 67 0 obj An OATS procedure can help preserve a joint. But it’s important to realize that rehabilitation requires 8 months or more of active participation—and, for competitive athletes, perhaps longer. /PageMode /UseNone %PDF-1.3 If that happens, another surgical procedure may be required. This minimizes wear on articular cartilage and keeps the transplanted meniscus from being exposed to excessive stress and abuse. stream Simple and reproducible. Meniscal injuries. This procedure replaces damaged areas of articular cartilage with new, healthy tissue of bone and cartilage, donated from a tissue bank or cadaver. Found at the end of the bones, cartilage helps joints glide smoothly and without pain, giving the knee flexibility. University Hospital of Sharjah conducts Meniscus Allograft Transplantation to alleviate severe knee pain and prevent degenerative arthritis MAT is a minimally invasive transplant surgery that takes 90 minutes to complete85 per cent of MAT patients have expressed high satisfaction after surgery May 17, 2021 As an ideal prevention against degenerative arthritis, the University Hospital of… Meniscal allograft transplantation (MAT) may improve symptoms and function, and may limit premature knee degeneration in patients with symptomatic meniscal loss. Cartilage doctor, Dr Prodromos at Illinois Sports Medicine and Orthopaedic Centers offers cartilage treatments by performing osteochondral allograft transplant to repair . 0000008069 00000 n Other surgeries, such as ligament or cartilage repairs, may be done at the time of the meniscus transplant or with a separate surgery. The procedure also requires one larger incision that the surgeon will use to tie the sutures that are passed through the donor meniscus and joint capsule. /ArtBox [ 9 9 594 792 ] Chalmers, Peter (2013). Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. But for people who are missing the meniscus and have pain, it can be very successful. Simplified graft preparation and recipient tibia preparation, to allow for the transplant to be positioned anatomically and anchored with reliable fixation, is the ultimate goal of the procedure. In other cases, especially in younger patients, the surgeon might perform a meniscal repair, a surgery in which the torn meniscus is stitched together. The average meniscus transplant cost in the United States varies from $10,000 to $30,000 depending on the surgical approach, hospitalization period, the fee of the surgeon and the geographical location from where the surgery is done. advertisement. The new meniscus is sewn in place and requires postoperative protection to allow healing. You will need crutches for 6 weeks to prevent putting full weight on your knee. In general, meniscus transplants last longer and are more successful when the patient’s knee joint is stable and properly aligned. The new meniscus is taken from a person who has died (cadaver) and donated their tissue. And that increases the chances of developing osteoarthritis, a painful form of arthritis that may require knee replacement surgery. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Appointments: Rehabilitation appointments begin within 3-5 days after surgery and meet about once per week. The success rates for a transplant varies. The new meniscus is taken from a person who has died (cadaver) and donated their tissue. The surgeon inspects the cartilage and ligaments of your knee, confirming that a meniscus transplant is appropriate, and that you don't have severe arthritis of the knee. Meniscus allograft transplantation may be recommended for knee problems such as: Risks for anesthesia and surgery in general are: Risks for meniscal transplant surgery are: Tell your health care provider what medicines you are taking. Found inside – Page 3685. Lubowitz JH, Verdonk PC, Reid JB 3rd, Verdonk R. Meniscus allograft transplantation: a current concepts review. Knee Surg Sports Traumatol Arthrosc. Epub 2017 Nov 29. Meniscus allograft replacement surgery is a minimally invasive method to restore previously removed torn knee cartilage with cadaver tissue. Sixty patients who underwent MAT between 2008 and 2014, aged 18-50 . Found inside – Page 163This paper describes the use of a femoral distractor during meniscus allograft transplantation. The improved visualization and access provided by the ... “In the case of extensive meniscus tissue loss in the knee, there are treatment options such as meniscus allograft transplantation or osteotomy, or even nonsurgical treatments such as the use of unloader braces,” says Christina Allen, MD, chief of Yale Medicine Orthopaedics & Rehabilitation Sports Medicine and head team physician for Yale Athletics. In a meniscus transplantation, a surgeon implants a new meniscus (taken from a cadaver) into a patient's knee joint. URL of this page: //medlineplus.gov/ency/article/007209.htm. is among the first to achieve this important distinction for online health information and services. Follow instructions on when to stop eating and drinking before the surgery. Found inside – Page 303Despite a high incidence of meniscal injuries after PCLbased knee injuries, ... In lateral meniscal allograft transplants, peak local contact pressures ... Found inside – Page 180Initially, the meniscal allograft heals to the peripheral transplant-host rim junction, providing the initial stability of the meniscal allograft within the ... /CropBox [ 9 9 594 792 ] 2018 ;25(6): 1091 - 1099 . Lateral meniscus allograft transplantation (LMAT) using the bone plug technique. Overview. Other pathologies leading to osteochondral defects include abnormal bone growth and excessive stress in the knee [7]. This is the largest series reporting return to sports and activity outcomes following osteochondral allograft transplant in the knee. Found insideOSTEOCHONDRAL AND AUTOLOGOUS CHONDROCYTE TRANSPLANTATION Overall ... after osteochondral allograft transplant (78%); however, only 30% of knees with ... Knee. Found inside – Page 153The important points to emphasize are that the limb transplant is a nonvital ... May JW (1983) Vascular knee allograft transplantation in a rabbit model. In the vast majority of cases, patients are able to return to daily activities with less pain and fewer symptoms. 0000006090 00000 n >> << /S 196 /L 287 /Filter /FlateDecode /Length 67 0 R >> Found inside – Page 99Arthroscopy. 2015;31(4): 746–754. Zouzias IC, Bugbee WD. Osteochondral allograft transplantation in the knee. Sports Med Arthrosc Rev. These are then precisely adjusted to create 7-mm cylindrical blocks. Many scientific papers will quote success rates for a meniscus allograft transplant (MAT) in a range of 70-85%. endobj Your leg and knee area will be numbed so that you do not feel any pain. In this procedure, a donor meniscus is inserted into the knee joint, which can allow young, active people to return to daily activities and can even help injured athletes return to their sport. Found inside – Page 2079The appropriate candidate for meniscal allograft transplantation should be skeletally mature but too young for total knee arthroplasty and have significant ... Osteochondral Autograft Transplantation of the Knee: Cartilage defect size is between 1.0cm² to 2.5cm² in total area . Meniscal Allograft Transplantation (MAT) If the cushion-like meniscus of the knee has previously been surgically removed, the knee can prematurely degenerate. Protection of post-surgical knee. Found inside – Page 277Fifteen subjects reported mild soreness with knee flexion at the time of follow-up. Osteochondral Allograft Transplantation When OLTs are too large, ... 4,8 However, rates of RTS after OCA transplantation in the knee have been critically examined for only unipolar focal cylindrical, or "plug," grafts for femoral condylar lesions. Hypothesis: We hypothesized that osteochondral allografting is a successful method for treating OCD of the knee. Be sure to arrive on time. If any tissue is left from your old meniscus, it is removed. Meniscus transplant; Surgery - knee - meniscus transplant; Surgery - knee - cartilage; Arthroscopy - knee - meniscus transplant. Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic surgeries. Inability to play sports or other activities, Failure of the surgery to relieve symptoms. 0 Purpose: To describe a 28-year experience with osteochondral allograft transplantation in . Keywords: osteochondral allograft transplantation; knee; cartilage; repair Chondral lesions constitute a common finding during knee arthroscopic surgery, with a reported prevalence of up to 63% to 66% and localized cartilage defects found in 20%. Found inside – Page 660DEF deficient, OAT osteochondral autograft transplantation, OCA osteochondral allograft transplantation the overall status of the knee joint with a ... H�b```f``Y���� \��ǀ |,l@���;��D��K������Ϝ��P����!��}i)�&��ğq�̏Z+%��V|Q�����LE���P�J��˰5�C����>��$���F0�et0��et400��H�4�b3B،�iil@�c�@���s�V b5��(/����^ Fn�h�����,``Uc`�f`i���``���(ŘﯲZ"A�놝�<0��00�\��� ��K� 255 Am J Sports Med. trailer An osteoarticular allograft is a piece of bone and cartilage that has been obtained from a young donor and is implanted into a full-thickness cartilage defect in one's knee. Meniscal allograft transplantation is surgery in which a meniscus -- a c-shaped cartilage in the knee -- is placed into your knee. The anterior and posterior horns are marked, and 8-mm bone blocks are grossly created with an oscillating saw. Product. The most common allograft procedure in the UK is ACL reconstruction where non-bone tendons are routinely used to replace damaged ligaments in the knee. Samitier, Gonzaslo (2015). Osteochondral Allograft Transplantation of the Knee in Patients Aged 40 Years and Older. 66 0 obj It is most commonly needed after a patient has had part of their meniscus removed (meniscectomy) during surgery. There are several causes of cartilage deterioration, including: Window. /Type /Page Infection (both bacterial and viral). /Parent 31 0 R None Raised Depressed Uniform Dropshadow. The menisci are critical to proper functioning of the knee. Cartilage allograft, also called osteochondral allograft (OCA) is a type of graft used during a special surgical procedure called osteochondral allograft transplantation surgery (OATS). Sometimes, a torn meniscus heals on its own, but often surgery is required. Since many factors contribute to differences in condyle geometry, even a size-matched orthotopic allograft, does not assure that the surface . Typically this will be divided into four or five phases with the goal of a gradual and safe return to normal life, including—for athletes—getting back to their sport. 0000001538 00000 n • Allograft revascularization is slower than for autografts. Meniscal transplantation . Osteoarticular allografts need to be sized correctly, tested to ensure there are no bacteria and viruses, which usually takes a minimum of 14 days, and implanted into a . Kidney Transplantation in Recipients and Donors with HIV: Long Term Follow up Study, Phase III Randomized Study of Crenolanib Versus Midostaurin Administered Following Induction Chemotherapy and Consolidation Therapy in Newly Diagnosed Subjects With FLT3 Mutated Acute Myeloid Leukemia. 2. Limited outcome data are available on osteochondral allografts in the pediatric and adolescent patient populations. Philadelphia, PA: Elsevier; 2017:chap 51. The replacement core is gently tapped into place until it lines up with the surrounding tissue. Meniscal allograft transplantation surgery is usually done via knee arthroscopy, a minimally invasive surgical technique that minimizes scarring and usually allows for an earlier start to physical therapy. If the injury was so severe that surgery was required to remove a large portion of the meniscus—a shock absorber critical to healthy knee function—your knee joint may be prone to a chronic, painful condition called osteoarthritis. The Collagen Meniscal Implant (CMI) is an implant derived from bovine collagen used to treat acute or chronic . In some cases, the surgeon will perform an ACL reconstruction or revision (re-do), correct limb alignment, or repair articular cartilage damage in combination with the meniscal transplantation. 13th ed. 0000002865 00000 n Editorial team. The donated meniscus is tested in the lab for any diseases and infection. Found inside – Page 261Sekiya JK, Ellingson CI: Meniscal allograft transplantation, ... Millett PJ: Rehabilitation of the arthrofibrotic knee, Am J Ortho 32(11):531–538, 2003. The graft material may either be harvested from the patient's own body which is known as autograft or from a cadaver known as an allograft. Found inside – Page 44Box 7–1 Indications for Osteochondral Allografts in Complex Knee ... plugs or shell graft Combined tibial plateau allograft and meniscal transplantation, ... In: Azar FM, Beaty JH, Canale ST, eds. A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). This technique is similar to that of osteochondral autograft transfer, but it involves taking a larger amount of tissue from a cadaver rather than from the patient's own knee. startxref >> Found inside – Page 181... and meniscal allograft transplant in younger patients. This management method should optimize knee stability and chondral protection. It includes patients with a wide range of activity levels but does not specifically note the inclusion of college or professional athletes. It is crucial that the size of the donor meniscus match the patient’s meniscus. /Info 30 0 R Philadelphia, PA: Elsevier; 2020:chap 94. A replacement core made up of cartilage and bone from another site in the knee (autograft) or a tissue donor knee (allograft) is then made to fit into the hole. Meniscal allograft transplantation is surgery in which a meniscus -- a c-shaped cartilage in the knee -- is placed into your knee. Ask your provider for help. Fresh osteochondral allograft (OCA) transplantation can restore both bone and cartilage defects characteristic of OCD. >> The Arthrex approach to osteochondral transplant is the Allograft OATS ® Set, Large; a family of orthobiologic products that facilitate harvesting of large diameter osteochondral/hyaline cartilage cylinders from an allograft bone. Follow any discharge and self-care instructions you are given. Found inside – Page 193Healing of large diaphyseal allograft transplants. An experimental study. ... Reconstruction of musculoskeletal defects about the knee for tumor. Osteochondral autograft transplantation uses cartilage from the patient. This is an important consideration in counseling patients on their long-term sports and activity goals. Restore normal knee range of motion and patellar mobility. Arthroscopy. 0000007344 00000 n Found inside – Page 246... requirement of the database: (anterior cruciate ligament) AND (surgery OR operate OR transplant OR graft OR autograft OR allograft OR reconstruction). 's editorial policy editorial process and privacy policy. The indication for revision TKA was infection in one knee, periprosthetic fracture in one knee, and patellar allograft resorption with flexion instability in one knee. The success rate of this procedure for properly selected . Background: Multiple studies in adults have shown that osteochondral allograft transplantation is an effective treatment option for large chondral and osteochondral defects of the knee. The arthroscope is inserted into your knee through a small incision. 0000009880 00000 n 2018; 34 : 1105-1112 View in Article Study design: Case series; Level of evidence, 4. Orthopaedic surgeons who use allograft tissue must understand the tissue banking process to provide safe and effective Physical therapy is useful to regain full function of the knee, which occurs on average 6 months after . /PageLabels 29 0 R Fresh osteochondral allograft transplant (OCA) is an increasingly popular technique involving the single-stage transfer of mature hyaline cartilage-bone dowels into large chondral defects of the knee. Lateral meniscus allograft transplantation (LMAT) using the bone plug technique. As life happens, so do injuries, especially those that occur when we least expect them. /Type /Catalog Osteochondral Allograft Transplantation Femoral Condyle Physical Therapy Protocol Phase I: Protection (Weeks 0 to 6) Goals • Protection of healing tissue from load and shear forces • Decrease pain and effusion • Restoration of full passive knee extension • Gradual improvement of knee flexion • Regaining quadriceps control Weight Bearing