Microfracture — Femoral Condyle

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Lesion-size-dependent: small lesion (<2cm2) NWB in brace 1-4 wks then wean to FWB in brace by 6 wks; large lesion (>2cm2) NWB in brace 1-6 wks then wean to FWB in brace by 8 wks; TROM brace locked in extension for ambulation x6 wks both lesion sizes

Key Restrictions

Brace locked in extension for ambulation per lesion size; wean from TROM brace Phase II; small lesion avoid high-impact sports until 6-8 months, large lesion until 9-12 months

Timeline & Phases

Phase I (surgery-6 wks): protect healing tissue, reduce swelling, control pain, gradually restore knee ROM/quad activation, brace locked in extension for ambulation per lesion size protocol above, ROM as tolerated, ankle pumps, quad sets, 4-way SLRs, multi-angle isometrics, active knee extension 90-40 deg (no resistance), prone TKE, clamshells, small lesion at 4 wks initiate weight shifts/toe calf raises/partial WB leg presses 0-60 progressing to 0-90 at 6-8 wks, large lesion at 6 wks initiate weight shifts/toe calf raises/partial WB leg presses at 8-10 wks, UBE/upper body circuit, stationary bike low resistance after 4 wks; progress to Phase II after 6 wks if full ROM, minimal pain, fair quad activation; Phase II (6-12 wks): gradually improve quad strength/endurance, improve tolerance to functional activities, wean from TROM brace, continue patellar mobilizations, gluteal strengthening progression to 4-way leg raises, DL bridges, standing TKE, proprioceptive drills, small lesion initiate front lunges/wall squats/step-ups then mini-squats 0-45 deg at 8-10 wks, large lesion toe calf raises then front lunges/wall squats/step-ups at 8-10 wks, stationary bike low resistance advancing as tolerated; progress to Phase III when 20 SLR with no extensor lag, 10 single leg step-downs with good form, no reactive effusion; Phase III (12+ wks): gradual return to full unrestricted functional activity/sport, leg presses 0-90 deg, bilateral squats 0-60 deg, unilateral step-ups 2in to 8in, core strengthening, forward lunge/squat holds/fire hydrants/balance/proprioceptive exercise, stationary bike with resistance/Stairmaster/swimming/NordicTrack/elliptical, increase walking tolerance; after 18 wks plyometric training (double-to-single leg hopping, agility/balance drills); small lesion at 20 wks begin jogging/running (avoid high-impact sports until 6-8 months); large lesion at 24 wks begin jogging/running (avoid high-impact sports until 9-12 months)

Notes

OSMS Rehabilitation Guidelines; produces fibrocartilage (less resilient than natural hyaline cartilage) rather than true cartilage regeneration; weight-bearing progression based on lesion size, location, and intra-op MD parameters; references Wilk & Brotzman, Clinical Orthopedic Rehabilitation (Mosby-Yearbook, 2003)