Post-Operative Rehabilitation For Microfracture Surgery

Often times a microfracture procedure is done in conjunction with another procedure (ACL/meniscus repair). When this is the case your physician may give you customized weight bearing status and range of motion (ROM) restrictions. Please follow these instructions more closely than the following protocols – which are a guideline to use in your rehabilitation.

Immediate Post-Operative Phase

Post-Op Days 1-4:

  1. Brace – Post-Op brace locked in zero degrees extension
  2. Non Weight Bearing – Two crutches w/ brace locked at zero degrees
  3. Exercises:
    • Ankle Pumps
    • Quad sets, Gluteal Sets
    • Straight Leg Raises
    • Hamstring and Gastroc, Stretching
    • Heel Slides
  4. PROM- Zero extension increase top 90 degrees as tolerated with pain.
  5. Ice and Elevation – Ice 20 minutes out of every hour and elevate knee in extension.

Post-Op Days 5-7:

  1. Brace – Continue with brace locked at zero extension
  2. Weight Bearing – Toe Touch Weight bearing as tolerated with crutches
  3. ROM – PROM: 0-90 degrees as tolerated, perform self PROM out of brace 4 to 5 times per day
  4. Swelling/Pain Control: Ice, elevation compression, electrical stimulation – PRN
  5. Ice & Elevation at Home: 20 minutes out of every hour elevate knee in extension
  6. Exercises:
    • Ankle Pumps
    • Quad Sets w/ EMG BFP or E. Stim PRN
    • Straight Leg Raises (4 plane)
    • Hamstring and Gastroc. Stretching
    • 4 Plane Tubing Exercises
    • Scar mobilization
    • Passive knee extension and flexion 0-90 degrees
    • Body master, hip abduction, flexion, extension

Maximum Protection Phase 

Goals: Absolute control of external forces and protect repaired meniscus

  • Prevent quad atrophy
  • Decrease pain and swelling
  • Gradual restoration of PROM
  • Stimulate collagen healing, decrease fibrosis

Week 2:

  1. Brace – Locked at zero degrees, continue to perform self ROM out of brace 4 to 5 times a day.
  2. Weight Bearing – Full weight bearing w/ crutches and post-op brace locked at zero degrees.
  3. PROM – 0-90 degrees as tolerated
  4. Exercises:
    • Straight leg raises (4 plane)
    • Tubing – 4 planes
    • Heal slides 0 to 90 degrees as tolerated
    • Ankle pumps
    • Quad sets w/ BFB or electrical stimulation PRN
    • Prone hamstring curls to 90 degrees as tolerated
    • Hamstring/Gastroc stretching
    • Seated heel raises
    • Knee extension 90 to degrees to 30 degrees
  5. Swelling/Pain Control – continue w/ ice compression, elevation, electrical stimulation – PRN

Weeks 3-5:

Goals: Prepare/progress patient to full weight bearing w/o crutches in post-op brace locked at zero extension

  1. Brace – locked at zero extension for weight bearing/ambulation
  2. Weight bearing – full weight bearing w/ progression to ambulation w/ brace unlocked at week 6
  3. ROM – AROM 90 degrees increase 30 degrees, PROM zero degrees increase to 120 degrees by week 6 as tolerated.
  4. Exercises:
    • Quad sets w/ BFB or electrical stimulation, PRN
    • 4 plans SLR
    • Hamstring curls to 90 degrees
    • Knee extension 90 degrees increase to 30 degrees w/ wight as tolerated – progressing 1-2 per week
    • Mini squats 0 degrees increase to 30 degrees
    • Stretching hamstrings, calf, hip
    • Shuttle leg press
    • Proprioception/unilateral balance w/ brace locked at zero extension
    • Dontigny TKE exercises
    • 4 plane tubing hip AROM
    • Standing heel raises
    • Body master hip PRE
    • Bike, stair master as week 4
  5. Swelling/Pain Control – continue w/ ice compression, elevation, electrical stimulation – PRN
  6. Soft Tissue/Scar Mobilization – continued

Criteria for Full Weight Bearing:

  1. No extension deficits
  2. Good quad control
  3. Minimal effusion

Weeks 6-12:

Goals: Return to normal gait, control forces w/ walking and restore proprioception.

  1. Brace – D/C post-operative brace
  2. ROM – 0 to 120 degrees and greater
  3. Exercises:
    • Continue previous exercises, increase proprioception drills (star drill)
    • Increase closed kinetic chain activity (i.e. step-ups)
    • Progression to jogging and agilities as tolerated at weeks 10 – 12 if Isokinetic evaluation demonstrates 20 degrees or less strength deficits.