Microfracture Treatment Of Articular Cartilage Defects (Tibiofemoral) Post-Surgical Rehabilitation Protocol |
POST-OP DAYS 1 – 14 |
• Dressing:
– POD 1: Debulk dressing, TED Hose in place
– POD 2: Change dressing, keep wound covered, continue TED Hose
– POD 7-10: Sutures out, D/C TED Hose when effusion resolved
• Crutches: Toe touch weight bearing (TTWB) x 6wks, No Brace
• CPM – Speed and ROM to patient tolerance, begin with 0-45 (8hrs daily)
• AAROM, AROM as tolerated
• Passive extension with heel on bolster or prone hangs
• Patellar mobilization (teach patient)
• Calf pumping
• Short arc quads, 0-20 only, without resistance
• Standing HS curls in parallel bars
• Straight leg raise (SLR) x 4 with knee in brace
• Electrical stimulation in full extension with quad sets and SLR
• Stationary bicycle for ROM, seat adjusted high, no resistance
• No Resisted Closed Chain ex x 6 weeks
• No Resisted Open Chain ex x 6 weeks
GOALS :
• CPM or bicycle: 500 cycles or more per day the first week
• 1000 cycles or more per day thereafter
• Full extension
Weeks 2 - 4 |
• Crutches with TTWB x 6 weeks
• Continue appropriate previous exercises
• Scar massage when incision healed
• D/C CPM once patient is independent with stationary bicycle
• AROM, AAROM as tolerated
• Co-contractions quads / HS at 0, 30, 60, 90 degrees
• SLR x 4 on mat (no brace) – Add light weight below the knee if good quad control
• Pool therapy:
– Deep water (chest/shoulder) walking and ROM exercises
– Water jogging floating upright in deep water
• Stretches – Hamstring, hip flexors, ITB
GOALS :
• No extensor lag
• No effusion
WEEKS 4 - 6 |
• Crutches TTWB
• Continue appropriate previous exercises
• PROM, AROM, AAROM to regain full motion
• Standing SLR x 4 with Theraband (standing on uninvolved LE)
GOAL :
• Full AROM
WEEKS 6 - 8 |
• Weight bearing as tolerated (WBAT), D/C crutches when gait is normal
• Continue appropriate previous exercises
• Leg press with light weight
• Mini squats, Wall squats
• Hamstring curls – Carpet drags or rolling stool (closed chain)
• Treadmill – Forwards and backwards walking
GOAL :
• Normal gait
WEEKS 8 - 12 |
• Continue appropriate previous exercises
• HS curl weight machine
• Knee extension weight machine
• Proprioceptive training – BAPS, ball toss, body blade
• Fitter
• Slide board
• Forward, lateral and retro step downs
• Stationary bike – Minimal resistance
• Treadmill – Walking progression program
• Elliptical trainer
• Pool therapy – Waist deep water walking or slow jogging
• Quad stretches
GOALS :
• No thigh atrophy
• Walk 2 miles at 15 min/mile pace
MONTHS 3 - 4
• Continue appropriate previous exercises with progressive resistance
• Treadmill – Running progression program
• Stairmaster
GOAL :
• Run 2 miles at easy pace
MONTHS 4 - 6 |
• Continue appropriate previous exercises
• Agility drills / Plyometrics
• Sit-up progression
• Progressive weight training program
• Transition to home / gym program
GOAL :
• Return to all activities
* NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP * |