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 Tibiofemotal
Rehabilitation Protocol for Patients with Chondral Defects on the Femur or Tibia
Post-op Days 1 – 14
Dressing:
POD 3: Change dressing, keep wound covered, continue TED Hose
POD 14: Follow up clinic
Crutches: Toe touch weight bearing (TTWB) x 6wks, No Brace
AAROM, AROM as tolerated – Speed and ROM to patient tolerance, begin with 0-45 (8hrs daily)
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
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
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*