Jordi Sanchez-Ballester

FRCSEd FRCS Trauma & Orth

Consultant Foot, Ankle & Knee Surgeon

Fairfield Independent Hospital, St Helens

Spire Cheshire

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

Medico Legal

Nuria Roig

07894 717377

St Helens & Knowsley

Claire Lomax

0151 290 4234

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


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


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



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


Normal gait

Weeks 8 - 12

Continue appropriate previous exercises

Hamstring curl weight machine

Knee extension weight machine

Proprioceptive training – BAPS, ball toss, body blade


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


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



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


Return to all activities


DOWNLOAD: Microfracture Patellofemoral Protocol leaflet