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Via Vivaio 22, 20122 Milano

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AGE: _______








  1. What is MCI?


Mesenchimal stem cells implantation (MCI) is a process whereby mesemchimal stem cells are collected from the bone marrow (iliac bone) and implanted into the cartilage damaged area of the knee, after a specific process of concentration by a centrifuge. This would allow cell growth and cartilage repair to occur producing new, durable cartilage.


  1. Immediate Post-operative Protocol


The day after the surgery, you will start some easy exercise to prevent vascular complications and muscle hypotrophy. Depending on type and site of the lesion limb will be placed in the next days / weeks on a Continuous Passive Motion Machine (CPM) on a continuous or intermittent basis. Every two-four hours, you will be required to stop the machine with the leg straight and carry out a program of contraction exercises for the thigh muscle to regain control of the knee.


You will be in the hospital for 2-3 days. During this time, the physiotherapist will instruct you how to go about walking with crutches wearing a straight-leg splint touching the operated foot to the ground without putting weight on the leg. The brace should be worn day and night and removed only when doing rehabilitation exercises and for showering..


  • Post Operative Rehabilitation Protocol – Upon Discharge


Note: The post-operative regimen is a standard guide, however each patient is different and the program is modified according to the patient’s progress and capabilities. 


Rehabilitation Protocol


Phase 1:  Proliferative/ Protective Phase (0-6 weeks)




  • protect the transplanted graft from excessive loads and shearing forces
  • control pain and reduce inflammation
  • gain full extension and gradual recovery of knee flexion
  • regain neuromuscular control of quadriceps muscle


  1. Brace
    1. Keep brace locked at 0 degrees of extension during ambulation and nights for at least 4 weeks


Weight bearing (2 crutches):

  1. non-weight bearing for the first 2 weeks
  2. toe-touch ambulation for the following 3-4 weeks
  3. partial weight-bearing for 5-6 weeks


  1. For pain control and swelling
    1. Cryotherapy (ice compression)
    2. Compression stockings
    3. Anti-inflammatory


  1. ROM
    1. Keep the knee in full extension without mobilization for the first 2 weeks
    2. CPM (0-30 deg) for 6-8 hours per day after surgery (depending from Surgeon indication)  for 1 week, then additional increase of 5 degrees per day as tolerated to reach the following degrees:
  1. 30 degrees flexion after the first week
  2. 45 degrees flexion after the second week
  • 60 degrees flexion after the third week
  1. 90 degrees flexion after the fourth week
  2. 105 degrees flexion after the fifth week
  3. 120 degrees flexion after the sixth week


  1. Strengthening exercises (10-20 reps x 2-3 sets)
    1. Quadriceps setting exercises
    2. Straight leg raises with knee locked in extension
    3. Gluteus, abductor and adductor hip muscles
    4. Active plantar flexion-extension
    5. Pool exercises from 3rd week
    6. Isometric leg press at multiple angles of flexion (0 deg – 15 deg – 30 deg) after 6 week.
    7. Stationary cycling without resistance once with 90 degrees of flexion (after 4th week)



  1. Quadriceps and VMO muscle electrical stimulation as needed



  1. Non weight bearing proprioceptive exercises







  • minimum pain and swelling
  • recovery of complete passive extension and flexion of approximately 120 degrees
  • adequate quadriceps recruitment



Phase 2: Transition Phase (6-12 weeks)





  • gait retraining
  • increase the strength of the quadriceps and flexors
  • gradual increase in functional activities


  1. Brace
    1. Maintain until with sufficient quadriceps strength for ambulation and during SLR exercises


Weight Bearing

    1. Progress to full weight bearing and abort the use of crutches by 6-8 weeks post implantation as tolerated


  1. Start gentle multidirectional patella mobilization


  1. Discontinue CPM but proceed with active and passive ROM exercises


  1. Strengthening exercises
    1. Quadriceps and hamstring exercises
    2. Hip and calf muscles exercises
    3. Pool exercises
    4. Stationary cycling with resistance as tolerated (may lower seat as comfort may allow)
    5. Isometric leg press at multiple angles of flexion (0 deg – 30 deg and progressively at 60 deg – 90 degrees depending on site lesion)
    6. Closed kinetic chain terminal knee extension exercises (0-40 deg)


  1. Quadriceps and VMO muscle electrical stimulation as needed



  1. Progression from non weight bearing to weight bearing proprioceptive exercises as tolerated






  • complete ROM (0-135 deg)
  • approximately 70% quadriceps and flexor strength compared to contralateral limb
  • absent or minimum pain and swelling
  • normal gait pattern



Phase 3: Maturation Phase (12-24 weeks)





  • further increase in quadriceps and flexor strength and resistance
  • further increase in functional activities



  1. Brace
    1. Not needed at this stage


Weight bearing

    1. full weight bearing without assistive devices as comfort would allow



  1. Strengthening Exercises
    1. Leg press (0-90 deg)
    2. Closed chain kinetic exercises (elastic leg press, half-squats 0-60 deg)
    3. Open chain kinetic exercises (elastic resistance, leg extension in non painful ROM progressively until 90-0 degrees)
    4. Leg curl (0-90 deg)
    5. Step exercises



  1. Continue patellar mobilization


  1. Proprioception weight bearing exercises at increasing difficulty level



  1. Increase Functional Activities
    1. Treadmill jogging
    2. Cycling on level surfaces
    3. Swimming





  • complete ROM (0-135 deg) without pain
  • approximately 90% quadriceps and flexor strength compared to contralateral limb
  • absence of pain and swelling
  • normal running pattern



Phase 4: Functional Recovery Phase (24-52 weeks)




  • gradual return to functional activities without limitations



  1. Strengthening Exercises
    1. Open and closed chain  kinetic exercises with progressive weight bearing, pylometric exercises
    2. Exercises focused at enhancing proprioception, agility, coordination as well as sport specific exercises (on field rehabilitation)



Note: Fully return to sport is not advised within ten-twelve months of implantation. Activities requiring standing and walking can commence however, all activities such as squatting, kneeling, stair-climbing, and bent knee activity should be delayed until six months from implantation, if possible.