Jordi Sanchez-Ballester
FRCSEd FRCS Trauma & Orth
Consultant Foot, Ankle & Knee Surgeon
Fairfield Independent Hospital, St Helens
Spire Cheshire
Bone-Surgeon.co.uk
Fairfield Independent Hospital
Crank Rd
St Helens
Merseyside WA11 7RS
01744 739311
Spire Cheshire Hospital
Chris Davies
Fir Tree Close
Warrington WA4 4LU
0845 602 2500
Microfracture Patellofemoral
Rehabilitation Protocol for Patients with Patellofemoral Chondral Defects
Post-Op Days 1 – 14
POD 3: Change dressing, keep wound covered, continue TED Hose
POD 14: Follow up clinic
Crutches: weight bearing as tolerated (WBAT), D/C when gait is normal
Brace 0-20 degrees x 6 weeks
ROM to patient tolerance, begin with 0-45 (6-8 hours daily)
Passive extension with heel on bolster or prone hangs
Patellar mobilization (teach patient)
Short arc quads, 0-20 only, without resistance
Standing Hamstring curls in parallel bars
Straight legraise (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
1000 cycles or more per day thereafter
Full extension
Weeks 2 - 4
Brace 0-20 degrees x 6 weeks
Continue appropriate previous exercises
Scar massage when incision healed
AROM, AAROM as tolerated
Co-contractions quads / Hamstring 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
BAPS, ball toss, body blade
Forward, backward, lateral walking in parallel bars
Double leg heel raises, progress to single leg
Goals
No extensor lag
No effusion
Weeks 4 - 6
Brace locked at 0-20 degrees
Continue appropriate previous exercises
PROM, AROM, AAROM to regain full motion
Standing SLR x 4 with Theraband bilaterally
Goal
Full AROM
Weeks 6 - 8
D/C brace
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
Hamstring 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*