Microfracture to the trochlea rehab protocol

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General Considerations

  • Weight bearing in full extension for 4 weeks post-op.
  • Wear a knee brace locked in full extension for 4 weeks unless otherwise instructed.
  • Regular manual treatment should be conducted to decrease the incidence of fibrosis. Avoid scar mobilization on surgical portals X 4 weeks or per MD.
  • Regular stretching of the posterior musculature is important to prevent a flexion contracture. Although ambulating in full extension, some loss of motion prior to surgery is not uncommon.
  • Imperative to work on recruiting quadriceps throughout the rehab process.
  • No resisted leg extension machines (isotonic or isokinetic) at any point.
  • No patellar mobilizations for 4 weeks.
  • Low impact activities for 3 months post-op.

*Use of the CPM for 6 hours a day for 4 weeks. Range of motion is 0-50 degrees for 4 weeks unless otherwise prescribed by MD.

Week 1

  • Nurse visit day 2 post-op for dressing inspection and review of 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.

Manual

  • Soft tissue treatments to posterior musculature, quadriceps, and effleurage for edema control.

Exercises

  • Straight leg raise exercises (lying, seated, and standing), quadriceps/ gluteal sets.
  • Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.

Goals

  • Decrease pain, edema.
  • Gait with brace locked in extension weight bearing as tolerated.
  • Range of motion 0 to 50 degrees.

Weeks 2 - 4

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

Manual

  • Manual resisted (PNF patterns) of the foot, ankle and hip.
  • -Continue with pain control, range of motion, soft tissue treatment.

Exercises

  • Continue with previous exercises; increase core exercises.
  • Non weight bearing aerobic exercises (i.e. unilateral cycling, Upper body ergometer, pool exercises).

Goals

  • Continue to decrease pain, edema.
  • Gait with brace locked in extension weight bearing as tolerated.
  • Range of motion 0 to 50 degrees.

Weeks 4 - 6

  • M.D. visit at 4 weeks post-op, progress to full weight bearing and wean off use of rehab brace as per MD.

Manual

  • Continue with soft tissue mobilization as needed, can initiate gentle patellar glides in neutral; work towards full range of motion.

Exercises

  • Incorporate functional exercises (i.e. mini depth squats, modified lunges, Shuttle, calf exercises).
  • Balance/proprioception exercices.
  • Stationary cycling, light resistance to no resistance, slow cadence.
  • Slow to rapid walking on treadmill (preferably a low-impact treadmill).
  • Ensure proper patellar tracking. Watch for lateral deviations.
  • Pool/deep water workouts after portals are completely closed with the use of a brace.

Goals

  • Wean off brace with gait, work towards full weight bearing.
  • Range of motion 0 to 110 degrees.

Weeks 6 - 8

Manual

  • Continue with soft tissue mobilization, patellar glides as needed.

Exercises

  • Road cycling once able to demonstrate good mechanics with light resistance for 30 minutes on a stationary bike.
  • Progress to road cycling once able to demonstrate good mechanics with light resistance for 30 minutes on a stationary bike.
  • Gradually increase the range of motion of closed and open-chain exercises.
  • Add lateral training exercises (i.e. side-stepping, theraband resisted sidesteps) once adequate strength has been demonstrated.
  • Functional tolerance, squats to 90 degrees without symptoms.
  • Gait without a limp.
  • Range of motion should be at least 90 % of normal.

Weeks 8 - 12

  • Full knee range of motion.
  • Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines).
  • Low-impact activities until 12 weeks post-op. Can progress to running once able to demonstrate adequate strength (i.e. single leg squat test). Start with a slow jog for 5-10 minutes than increase time and speed as comfortable. Consult PT if unsure of how to progress.
  • Patients should be pursuing a home program with emphasis on addressing strength deficits and sport/activity-specific training.
  • Initiate sport/activity-specific training

Weeks 12-20

  • Continue to progress program with increased intensity to return to sports and activities of daily living.
  • Initiate Sports Test 1 and slow progression to return to running program.

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.