Rehabilitation and Return to Play Protocols Following Osteochondral Autograft and Allograft Transplantation for Knee Chondral Lesions in Athletic Populations

PURPOSE OF REVIEW: Osteochondral autograft transplantation (OATS) and osteochondral allograft transplantation (OCA) are established cartilage restoration procedures for symptomatic chondral and osteochondral defects of the knee in athletes. Postoperative rehabilitation is central to graft healing and incorporation, functional recovery, and safe return to play (RTP). This review synthesizes contemporary evidence on rehabilitation after OATS and OCA, including weight-bearing progression, bracing, range of motion, blood flow restriction training, and RTP criteria. RECENT FINDINGS: Systematic reviews and survey studies report substantial variability in rehabilitation protocols, including weight-bearing timelines, bracing duration, continuous passive motion utilization, and RTP criteria. Few published protocols incorporate objective functional testing to guide RTP. Criteria-based frameworks that individualize progression by graft type, lesion location, and functional milestones are increasingly advocated, although supporting evidence remains limited. Blood flow restriction training may help preserve strength early after surgery, but data specific to OATS and OCA remain sparse. Return to play is commonly reported after both procedures, with earlier timelines more frequently reported after OATS than OCA. Rehabilitation after OATS and OCA requires balancing early graft protection with progressive restoration of motion, strength, and sport-specific capacity. Current evidence demonstrates wide protocol heterogeneity and continued reliance on time-based milestones, with underuse of objective RTP criteria. Standardized, criteria-driven pathways and multidisciplinary decision-making may improve consistency and optimize outcomes in athletic populations.