Microfracture Protocol for Patients

Patient Instructions Following Microfracture Procedure

This protocol is a guideline to help you begin exercising after microfracture surgery and should not be substituted for your physician’s advice. Always follow your physician’s instructions with regard to your individual care.

Surgery
Microfracture is an outpatient surgical procedure used to treat damaged areas of cartilage in the knee joint. During the procedure, a series of deep holes, or microfractures, are completed into the bone around the area of damaged cartilage. The microfractures are made deep enough to reach the underlying marrow, which stimulates healing and regeneration of tissue at the bone’s surface. 

Lesion Location
The location of the lesion and microfracture are important with respect to your rehabilitation. Your physician will explain the location of the lesion so that you know which of the following guidelines to follow.

Continuous Passive Motion (CPM)
A CPM machine may be applied immediately depending on the location of your knee lesion. Instructions will be issued with your CPM. If you were issued a brace, it may be removed during CPM use. You will use the CPM for 6 to 8 hours in a 24-hour period. This is important to optimize healing.

Passive Knee Range of Motion Exercise.
A is surgical knee, B is nonsurgical knee.
Passive Knee Range of Motion
If a CPM is not provided, follow this passive exercise alternative. “Passive exercise” requires you to relax the surgical knee and perform all of the lifting with your nonsurgical leg. Seated, use your nonsurgical leg to raise your surgical leg through your available range of motion (ROM). You can perform up to 500 repetitions (lift and lower) movements, three times per day. Begin this on postoperative day one.

Ice/Cryotherapy
Apply ice to the knee for 20 minutes every two hours during the day. If a polar care or cryotherapy machine was issued, apply this as instructed. The application of ice often decreases swelling and pain. This is continued until postoperative day seven.  

Crutches
Before you leave the hospital or surgery center, you will learn how to walk using crutches including instruction to “touch down weight bear” (TDWB). You should place no more than 20 percent of your body weight on the surgical leg. Unless instructed differently by your physician, you will use crutches to TDWB for six to eight weeks following your surgery. It is important to limit the weight placed on the involved limb as to not compromise the surgery and to optimize healing. Afterward, you will be able to put as much weight on the surgical leg as is comfortable. Your weight-bearing status will be determined by which part of your knee had the microfracture.

Brace
You may be issued a brace depending on which part of your knee had the microfracture. You may not need a brace until you increase your activity in a few weeks. If you are issued a brace initially, you may remove it to apply ice and to use the CPM machine, otherwise use as instructed by your physician.

Exercises
You will learn exercises when you initiate therapy. In the meantime, you may begin the following program illustrated below:

Partial Knee Bend Exercise Partial Knee Bends
Hold on to counter for support. Stand with “touch down weight bearing” (TDWB) on the surgical leg. Only 20 percent of your body weight is placed on the surgical leg. Perform 2 sets of 15 repetitions, 1 to 2 times a day. Begin on day two.

Quadriceps Strengthening Exercise

Quadriceps Strengthening
Rest leg over small towel roll. Tighten quadriceps muscle on front of leg, trying to push back of knee downward. Do not allow the heel to lift off the table. Hold contraction for 5 seconds, perform 15 repetitions, 1 to 2 times a day. Begin after week one.
Hamstring Stretch Exercise Hamstring Stretch
Using a towel, stretch the muscles on the back of your leg. Hold the stretch one minute, repeat two times, one to two times a day. Begin after week one.
Calf Stretch Exercise Calf Stretch
Using a towel, stretch the muscles on the back of your calf. Hold the stretch for one minute, repeat two times, one to two times a day. Begin after week one.
Abduction Hip Strengthening Exercise Hip Strengthening
Abduction: Hold on to counter for support. Raise surgical leg out to the side. Do not allow knee to bend. Repeat 15 times, 2 sets, 1 to 2 times a day.
Hip Strengthening Extension Exercise Hip Strengthening
Extension: Raise surgical leg behind you. Do not allow the knee to bend. Repeat 15 times, 2 sets, 1 to 2 times a day. Begin after week one. 

Femoral Condyle/Tibial Plateau Lesions

Day 1

  • After surgery, you will wake in the recovery room. A nurse will be there to monitor you.
  • Begin CPM or passive range of motion.
  • Wear brace, if issued.
  • Use crutches to walk, “touch down weight bearing” (TDWB) only.
  • Ice.

Days 2 to 14

  • Continue CPM and ice regimen
  • Begin the following exercises: partial knee bends, quadriceps strengthening, hamstring stretch, calf stretch and hip strengthening (see illustrations above)
  • Follow–up appointment with your physician between postoperative days 10 to 14
  • Your physician may recommend initiating physical therapy at this time or you will be asked to wait until six to eight weeks after surgery

Weeks 2 to 5

  • Begin riding stationary bike (without resistance) at week two if you have sufficient range of motion
  • Attend physical therapy

Weeks 6 to 8

  • Progress to full weight bearing (FWB) on the surgical leg
  • Discontinue crutch use during this time unless otherwise instructed by your physician

Week 16

  • Resume free weights and machines independently in gym

Patellofemoral/Trochlear Lesions

Day 1

  • After surgery, you will wake in the recovery room. A nurse will be there to monitor you.
  • Begin CPM.
  • Wear brace at all times to limit bending knee.
  • Use crutches to walk, WBAT.
  • Ice.

Days 2 to 14

  • Continue CPM and ice regimen
  • Begin the following exercises: quadriceps strengthening, hamstring stretch, calf stretch, hip strengthening (see illustrations above)
  • Follow-up appointment with your physician between postoperative days 10 to 14 

Weeks 2 to 8

  • You will progress to full weight bearing (FWB) on the surgical leg and discontinue crutch use during this time unless otherwise instructed by your physician

Weeks 8 to 16

  • Begin physical therapy during months two to four

Week 16

  • Resume free weighs and machines independently in gym

For More Information
To learn more about Sharp's rehabilitation services or to find a Sharp-affiliated physician who can refer you to a physical therapist, call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about rehabilitation, visit Rehabilitation in Adult Health or read the Rehabilitation News archive.