The rehabilitation program after microfracture
is crucial to optimize the success of the surgical technique.
The program is designed to promote the ideal physical environment
in which the bone marrow cells can transition into the appropriate
cartilage-like cell lines. When the ideal physical environment
is combined with the ideal chemical environment produced by
the marrow clot, a repair cartilage can develop that fills
the original defect.
The specific rehabilitation program
for each patient following a microfracture will vary depending
upon the following factors:
- The location of the defect
- The size of the defect
- Whether any other surgical
procedure, such as an anterior cruciate ligament reconstruction,
was done at the same time as microfracture
Following are examples
of some rehabilitation programs.
Rehabilitation Protocol for Patients with Chondral Defects
on the Femur or Tibia
Limited strength training
also begins immediately after microfracture surgery.
- The patient is started on
a continuous passive motion (CPM) machine immediately
in the recovery room. Ideally, the patient should use the
machine for 6 to 8 hours every 24 hours. Range of motion
is increased as tolerated until full range of motion is
achieved with the machine.
- If a CPM machine is not used,
the patient begins passive flexion/extension
(straightening and bending) of the knee with 500 repetitions
three times a day.
- The use of crutches, with
only light touch-down weight allowed on the involved leg,
is prescribed for 6 to 8 weeks. Patients with small
defect areas (less than 1cm in diameter) may be allowed
to put weight on the leg a few weeks sooner.
- Brace use is rarely recommended
for patients with chondral defects on the femur or tibia.
- Standing one-third knee bends
with a great deal of the weight on the uninjured leg begin
the day after surgery.
- Stationary biking without
resistance and a deep-water exercise program begin 1 to
2 weeks after surgery.
- After 8 weeks the patient
progresses to full weight bearing and begins a more vigorous
program of active knee motion.
- Elastic resistance cord exercises
can begin about 8 weeks following surgery.
- Free weights or machine weights
can be started when the early goals of the rehabilitation
program have been met, but no sooner than 16 weeks after
- Patients must not resume
sports that involve pivoting, cutting, and jumping for 4
to 6 months after a microfracture procedure. Full activity
may be resumed once the physician has examined the knee
and given approval for the patient to return to sports activity.
Rehabilitation Protocol for
Patients with Patellofemoral Chondral Defects
- All patients treated with
microfracture for patellofemoral defects must use a brace
set for 0° to 20° of flexion for at least 8 weeks.
It is essential to limit compression of the new surfaces
in the early postoperative period, so that the maturing
marrow clot will not be disturbed. The brace should be worn
at all times except when passive motion is allowed.
- Patients are placed into
a CPM machine immediately following surgery. The goal is
to obtain a pain-free and full passive range of motion
soon after surgery during those periods when the brace is
- When the patient wears a
brace, strength training is allowed, but only in the 0°
to 20° range immediately after surgery in order to limit
compression of the affected chondral surfaces. The joint
angles of these patients are observed carefully at the time
of surgery to determine where the defect makes contact with
the opposing surface, either on the patella or on the trochlear
groove of the femur. These areas are avoided during strength
training for approximately 4 months.
- Patients are allowed to put
weight on the involved leg as tolerated, but it must be
limited to the angles of flexion that do not compress
the treated surfaces. For this reason the patient must
wear a brace locked in limited flexion.
- After 8 weeks, the knee brace
is gradually opened to allow increased flexion of the knee,
a process that takes about a month. Brace use is generally
discontinued at about 12 weeks. Some patients, however,
like to continue to wear the brace for strenuous exercise
for a few more months up to about 6 months.
- After brace use is discontinued,
strength training advances progressively.
- The doctor must examine
the knee before the patient is released to full activity.