Microfracture of femoral condyle post-operative physical therapy protocol

General Considerations

  • Non-weightbearing status for 4 weeks post-op (resting foot on floor and driving are okay).
  • Depending on the location of the articular cartilage defect and subsequent graft, patients may have active and/or passive range of motion restrictions (this will be noted on the prescription); otherwise, push for full extension equal to opposite side.
  • Regular manual treatment should be conducted to the patella and all incisions; no direct scar mobilization at surgical portals X 4 weeks or per MD. Once cleared pay particular attention to the anterior medial portal--to decrease the incidence of fibrosis.
  • Light to no resistance stationary cycling is okay at 2 weeks post-op.
  • Early recruitment of the vastus medialis muscle will speed recovery.
  • No resisted leg extension machines (isotonic or isokinetic) at any point.
  • Low-impact activities for 3 months post-op.
  • Use of the CPM for 6 hours a day for 4 weeks is imperative.

Week 1

  • Nurse visit day 2 to change dressing and review home program.
  • Icing and elevation for 15-20 minutes every 2 hours during wake hours.
  • CPM (continuous passive motion machine) at home for 6 hours daily/at night.

Manual

  • Soft tissue treatments and gentle mobilization to posterior musculature, patellofemoral joint, quadriceps, and effleurage for edema.

Exercises

  • Straight leg raise exercises (lying, seated, and standing), quadricep/adduction/gluteal sets, passive and active range of motion exercises.
  • Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.

Goals

  • Decrease pain, edema.
  • Gait non-weightbearing x 4 weeks.
  • Range of motion 0-100 degrees or per MD.

Weeks 2 - 4

  • Nurse visit at 14 days for suture removal and check-up.

Manual

  • Continue with soft tissue mobilization, effleurage, and gentle range of motion.

Exercises

  • Manual resisted (PNF patterns) of the foot, ankle and hip; core stabilization. Non-weightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne arms only, well Leg cycling). AFTER 2 weeks, bilateral cycling with light to no resistance, slow cadence.

Goals

  • Decrease pain, edema.
  • Gait non-weight bearing x 4 weeks.
  • Range of motion 0-100 degrees or per MD.

Weeks 4 - 6

  • MD visit at 4 weeks post-op, will progress to full weight bearing and discontinue use of rehab brace

Manual

  • Continue with soft tissue mobilization, patellar glides, range of motion. Initiate scar mobilization if incisions are completely closed.

Exercises

  • Incorporate functional exercises (i.e. squats, linebackers, lunges, Shuttle/leg press, calf raises, step-ups/lateral step-ups).
  • Balance/proprioception exercises.
  • Slow to rapid walking on treadmill (preferably a low-impact treadmill).

Goals

  • Gait weight bearing as tolerated, progress from bilateral crutches->single crutch->no assistive device.
  • Range of motion 0 to 130 degrees.

Weeks 6 - 8

Manual

  • Continue with soft tissue mobilization, patellar glides, range of motion. Continue with scar mobilization as needed.

Exercises

  • Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines).
  • Add lateral training exercises (side-stepping, Theraband resisted side-stepping, lateral leaping onto toes as tolerated)
  • Road cycling as tolerated, in saddle with no clip-ins, and on flat surfaces; slow progression to incline.

Goals

  • Gait without a limp.
  • Range of motion should be at least 90 % of normal.

Weeks 8 - 12

  • Low-impact activities until 12 weeks.
  • Patients should pursue a home program emphasizing sport/activity-specific training.

Weeks 12+

  • Sports Test 1 at 12 weeks. Initiate return to running program.
  • Slow progression of sport-specific drills. Continue to increase strength, and endurance.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

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