Microfracture to the trochlea rehab protocol
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.