Evidence / Sources / E6
Dhillon J, Fasulo SM, Kraeutler MJ, Belk JW, McCulloch PC, Scillia AJ. The Most Common Rehabilitation Protocol After MACT Is Immediate Partial Weight-Bearing and CPM. Arthroscopy, Sports Medicine, and Rehabilitation 2022;4(6):e2115-23
Evidence strength 4 of 5
Systematic review · n = 25 studies / 905 pts (22 Level I, 3 Level II)MACI ITSELFDOI / full text →What it can tell you
What published MACT protocols actually did — across 25 studies and 905 patients, the most common pattern was immediate partial weight-bearing and early CPM. The best available map of practice.
What it cannot
Which of those choices caused good outcomes. Practice patterns show convergence of habit, not evidence of effect — and its own CPM table is thin: five of the eighteen studies using it reported neither hours per day nor total duration.
Everything on this site that leans on E6 — 50 claims
Stage II · Protection“In the first weeks the graft's fixation is mechanically vulnerable; shear is the threat. Studied protocols began passive motion within the first day — protection here means protect…”Stage II · Protection“Continuous passive motion appears in roughly three-quarters of published protocols and the US consensus initiates it within the first day at 0–30°. But no trial has isolated CPM as…”Stage II · Protection [patellofemoral]“Patellofemoral protocols in the consensus permit immediate weight-bearing in a brace locked in extension — the patellofemoral joint is barely loaded near full extension. What gets …”Stage II · Protection · Questions“My protocol says a specific number of CPM hours — is that your requirement, or the machine vendor's default?”Stage III · Loading“The graft is entering its soft maturation window — repair tissue is still measurably changing on imaging at 24 months, and this is the period where progressive compression is thoug…”Stage IV · Strength [tibiofemoral]“Closed-chain quadriceps work was already established — every protocol in the practice-pattern review that reported it had started by week seven — and this window progresses it towa…”Program · Stage II (patellofemoral)“Quadriceps sets — Push the back of the knee down, tighten the thigh, hold. Isometric work started around week one in half of published protocols.”Program · Stage II (patellofemoral)“Straight-leg raise, in the brace — The patellofemoral joint is barely loaded with the knee straight; a locked brace keeps it that way while the leg works.”Program · Stage II (patellofemoral)“Passive motion, staged arcs — Gained, never forced. CPM appears in about three-quarters of published protocols; no trial has isolated its dose.”Program · Stage II (patellofemoral)“Walking in the brace, locked in extension — The near-opposite of the tibiofemoral rule on which variable is rationed. If your surgeon restricted your weight-bearing, theirs wins — …”Program · Stage II (tibiofemoral)“Passive motion, from the first day — Gained, never forced. CPM appears in about three-quarters of published protocols; no trial has isolated its dose.”Program · Stage II (tibiofemoral)“Active flexion, early and unloaded — The near-opposite of the patellofemoral rule: flexion was never the protected variable here; weight was.”Program · Stage II (tibiofemoral)“Isometrics — quadriceps, hamstrings, gluteals — Push the back of the knee down, tighten the thigh, hold. Isometric work started around week one in half of published protocols.”Program · Stage II (tibiofemoral)“Straight-leg raises, all planes — The canonical protocol kept a brace on 24 hours a day for the first 3–4 weeks; the brace weeks in your protocol are its authors' convention.”Program · Stage III (patellofemoral)“Leg press, shallow arc only — Add load only when the previous week caused no swelling by the next morning. Both legs, then single.”Program · Stage III (patellofemoral)“Straight-leg raise, no lag — If the heel lifts late or the knee bends first, drop back to quad sets. Lag is the signal, not pain.”Program · Stage III (patellofemoral)“Passive flexion toward full range — Gained, never forced. Heel slides and wall slides; stop at resistance, not at pain.”Program · Stage III (tibiofemoral)“Active flexion to full range — The near-opposite of the patellofemoral rule. Flexion here was never the protected variable; weight was.”Program · Stage III (tibiofemoral)“Closed-chain quadriceps work begins — Weight-bearing exercise produces lower tibiofemoral shear than open-chain — the biomechanical reason protocols start here.”Program · Stage IV (patellofemoral)“Leg press, deepening the arc — Patellofemoral pressure climbs steeply as the knee bends under load. Depth is earned in this stage, never assumed.”Program · Stage IV (tibiofemoral)“Leg press, squats, lunges — the strength block — The patellofemoral program guards flexion depth in this window; this side guards load. Same stage, different dial.”Program · Stage IV (tibiofemoral) · Gates“Single-leg strength work progressing with a knee that is quiet by the next morning”Exercise Library · Quadriceps set (isometric)“Isometric quadriceps work started around week one in roughly half of published MACI protocols, and from the first days in the canonical tibiofemoral protocol.”Exercise Library · Straight-leg raise, in the brace“Straight-leg raises in a brace locked in extension appear across published patellofemoral protocols and in the US expert consensus as early-stage extensor work.”Exercise Library · Straight-leg raises, all planes“The canonical tibiofemoral protocol introduces straight-leg raises in all planes from weeks 2–3, alongside a brace worn 24 hours a day for the first 3–4 weeks.”Exercise Library · Passive motion, staged arcs“Continuous passive motion appears in roughly three-quarters of published cartilage-repair protocols, beginning at 0–30° within the first day in the US expert consensus and the cano…”Exercise Library · Active flexion, early and unloaded“The canonical tibiofemoral protocol works active-assisted flexion within 30° in the first week, 90° by weeks 2–3, and beyond 125° by weeks 4–6, with full active flexion generally p…”Exercise Library · Walking in the brace, locked in extension“Immediate weight-bearing as tolerated, in a brace locked in extension, is the patellofemoral position in the US expert consensus and the published protocol literature.”Exercise Library · Leg press, shallow arc“Closed-chain quadriceps work in a restricted shallow-flexion arc is the patellofemoral pattern across published MACI protocols and the canonical protocol literature.”Exercise Library · Closed-chain quadriceps work begins“Every protocol in the practice-pattern review that reported closed-chain work had started it by week seven — four of the twenty-five studies reviewed, and the only source that give…”Exercise Library · Passive flexion toward full range“Recovering unloaded flexion through weeks 6–12, while loaded flexion stays restricted, is the patellofemoral pattern in the US expert consensus and the published protocol literatur…”Exercise Library · Active flexion to full range“Full active flexion is generally permitted from week 6 in the canonical tibiofemoral protocol, with unweighted rowing-ergometer work as its published assist.”Exercise Library · Leg press, deepening arc“The expert consensus progressed patellofemoral loading by opening restricted flexion in steps rather than lifting the restriction at a date, and published protocols describe the sa…”Exercise Library · Leg press toward functional load“Terminal knee extension, leg press, and functional squats and lunges are the canonical tibiofemoral protocol's strength block for the three-to-six-month window.”What we don't know · № 03“Exercise selection, sets, reps and intensity have never been randomized at any stage.”What we don't know · № 07“No supporting modality — CPM dose, bracing, NMES, hydrotherapy, blood-flow restriction, proprioceptive work — has ever been isolated as a variable in cartilage repair.”What we don't know · № 20“Nobody has compared how fast to progress *within* a phase — only how fast to reach full weight-bearing.”Week ruler · week 3 (tibiofemoral)“The canonical protocol keeps a brace on around the clock for the first three to four weeks. When it comes off is your surgeon's call, and the range across published protocols is mu…”Week ruler · week 4 (tibiofemoral)“Eight of the twenty-five reviewed protocols trained balance and joint-position sense at all, and those that did began across a four-week spread rather than on a date. The canonical…”Week ruler · week 6 (tibiofemoral)“Ten protocols described a brace and they discontinued it anywhere across this whole window. This is the wide variation the week-three mark alludes to, stated as the range it actual…”Week ruler · week 7 (tibiofemoral)“Every protocol in the practice-pattern review that reported closed-chain work had started it by this week — four of the twenty-five reviewed, which is the whole basis for the numbe…”Week ruler · week 12 (tibiofemoral)“Thirteen protocols reported when full range arrived, and the slowest of them took until here. The fastest took three days. That span is the honest answer to “when should my knee be…”Hard limits · stage 3 (patellofemoral)“The arc opens in steps, and loaded work stays behind it until it does”Why this · Why so much of the first six weeks is a muscle that isn't moving“Isometric quadriceps work started at about week one in roughly half of the protocols in the practice-pattern review — the earliest and most consistently prescribed thing in this wi…”Why this · Why the joint is moved from the first day, and why nobody knows how much“Continuous passive motion appears in roughly three-quarters of published protocols and the consensus starts it within the first day at a short arc, moving the joint without asking …”Why this · Why the quadriceps work starts before the leg is allowed to carry you“Isometric quadriceps work started at about week one in roughly half of the protocols in the practice-pattern review, alongside straight-leg raises in all planes from the early week…”Why this · Why the joint is moved from the first day, and why nobody knows how much“Continuous passive motion appears in roughly three-quarters of published protocols and the consensus starts it within the first day at a short arc, with early active range beginnin…”Why this · Why the cap here is on load, not on depth“Full active flexion is generally permitted from week six in the canonical protocol, while closed-chain work stays shallow and two-legged — load advances before depth does, which is…”Why this · Why the arc opens in steps rather than lifting on a date“The consensus progressed patellofemoral loading by opening restricted flexion in steps rather than by lifting the restriction at a fixed point, and the canonical protocol places it…”Why this · Why this is where the real strength work starts“The canonical protocol places terminal knee extension, leg press, and functional squats and lunges in the three-to-six-month window, once full weight-bearing and a normal gait are …”
Read it like a sceptic
Protocol reporting in the underlying studies is thin; the review is only as granular as its inputs.
Population
MACT, knee
Selection policy
Sources enter the registry through docs/research — the evidence table records design, population, and size for every entry, and pages cannot cite anything outside it.