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Microfracture/Chondral Picking Treatment of Articular Cartilage Defects - Physical Therapy Protocol

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Preoperative Guidelines

  • Restore full AROM
  • Teach normal heel-toe gait
  • Strengthen involved extremity
  • Decrease effusion
  • Educate Patient on post-op protocol, use of crutches (level and stairs), importance of post-op extension

Note: Exercise prescription is dependent upon the location of the lesion, the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.

Phase I (Post-op Days 1 – 14)

  • No Resisted Closed Chain Exs x 6 weeks
  • No Resisted Open Chain Ex
  • Exercises/ROM should not result in increased pain or swelling
  • Tibiofemoral Defect: Crutches with Touch WB (x 6 weeks). No Brace
  • Patellofemoral Defect: Brace 0-20 (x 6 weeks), WBAT with crutches. D/C crutches when normal gait.
  • AROM as tolerated. Repeat ROM throughout day…Go through knee ROM 5-10 minutes every waking hour
  • Stationary bicycle for ROM, seat adjusted high, no resistance, many revolutions…progress to 1000 cycles or more/day
  • Passive extension with heel on bolster or prone hangs
  • Patellar mobilization (teach patient)
  • Scar massage when incision is well healed
  • Calf pumping
  • Standing HS curls in parallel bars
  • SLR x 4 with knee in brace (for patellofemoral defect) and if no lag
  • Electrical stimulation in full extension with quad sets and SLR\

Goals: Bicycle: 500 cycles or more per day the first week, 1000 cycles or more per day thereafter, Full extension, no increase in swelling or pain

Phase II (Weeks 3 – 5)

  • Continue appropriate previous exercises
  • AROM, AAROM as tolerated
  • SLR x 4 – add light weight below the knee if quad control is maintained
  • Pool therapy – deep water (chest/shoulder) walking and ROM exercise, water jogging
  • Stretches – HS, AT, Hip flexors, ITB
    Patellofemoral (brace locked at 0-20)
    • BAPS, ball toss, body blade, heel raises
    • Forward, backward, lateral walking in parallel bars
    • Weight-shifting
    • Well-leg Theraband

Goals: No extensor lag, full ROM, no effusion

Phase III (Weeks 6 – 8)

  • Tibiofemoral – WBAT, D/C crutches when gait is WNL
  • Patellofemoral – D/C brace
  • Continue appropriate previous exercises and stretches
  • Begin Well-leg Theraband exercises for tibiofemoral defects (continue for patellofemoral)
  • Leg press/Total Gym with light weight in pain free ROM
  • Mini squats
  • Wall sits for time (in pain free ROM)
  • Continue stationary bike. Add light resistance
  • Hamstring curls – closed chain (carpet drags or rolling stool)
  • Treadmill – Backwards and forward walking. Ensure proper heel-toe gait
  • Pool therapy – Waist deep water walking or slow jogging

Goals: Normal heel-toe gait, Wall sit for 3 mins, walk 2 miles at 18 min/mile pace

Phase IV (Weeks 9– 12)

  • Continue appropriate previous exercises
  • HS curls – open chain
  • Proprioceptive training – BAPS, plyoback, body blade, fitter, slide board
  • Lateral step downs in pain free range only
  • Continue stationary bike, gradually increase resistance. Keep seat high
  • Treadmill – Forward walking approaching 15 min/mile pace
  • Tibiofemoral – Elliptical trainer, Stairmaster (if gait pattern normal)
  • Patellofemoral – Elliptical trainer – No Stairmaster
  • Prone quad stretches

Goal: Walk 2 miles at 15 min/mile pace without edema or increased pain

Phase V (Months 3 – 4)

  • Gym Program
  • Continue appropriate previous exercises with progressive resistance
  • Treadmill – Running progression program
  • Begin light plyometrics (bilateral)

Goal: Run 2 miles at easy pace without increased pain or edema

Phase VI (Months 5 – 6)

  • Continue appropriate previous exercises
  • Progress Agility drills / Plyometrics (to single leg)

Goals: Return to all activities, Functional tests at least 90% of opposite leg to clear for sports and discharge (single leg hop and 12 meter hop for time)

No contact sports until 6 months post-op


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