Microfracture — Patellofemoral

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Structured WB progression in locked brace: wk1 25% BW, wk2 50% BW, wk3 75% BW, wk4 progress to FWB, wks6-8 progress to opening/weaning from brace; TROM brace locked in extension for ambulation x6 wks

Key Restrictions

No active NWB knee extension exercises Phase I; wean from TROM brace Phase II; ROM schedule: wk1 0-90, wk2 0-105, wk3 0-115, wk4 0-125, wk8 FROM; avoid high-impact sports until 6-8 months (small lesion) or 9-12 months (large lesion)

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, no active NWB knee extension exercises, structured WB progression (25% wk1, 50% wk2, 75% wk3, FWB wk4, brace opening/weaning wks 6-8), ROM progression (0-90 wk1, 0-105 wk2, 0-115 wk3, 0-125 wk4, FROM wk8), ankle pumps, quad sets, 4-way SLSs, multi-angle isometrics, active knee extension 90-40 deg (no resistance), prone TKE, clamshells, NMES to quadriceps, begin patellar mobilizations, small lesion weight shifts with knee in extension at 1-2 wks then toe calf raises/partial WB leg presses 0-60 progressing to 0-90 at 6-8 wks, UBE/upper body circuit, stationary bike low resistance after 4 wks; progress to Phase II after 6 wks if full passive knee extension, knee flexion to 125 deg, minimal pain, fair quad activation; Phase II (6-12 wks): full knee flexion by wk8, gradually improve quad strength/endurance, improve tolerance to functional activities, wean from TROM brace, patellar mobilizations, gluteal strengthening progression to 4-way leg raises, DL bridges, standing TKE, proprioceptive drills, small lesion front lunges/wall squats/step-ups at 6-8 wks 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; 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; companion protocol to OSMS's Microfracture Femoral Condyle document, sharing the same philosophy and Phase II-III content but with a more structured week-by-week WB and ROM progression specific to patellofemoral lesions; references Wilk & Brotzman, Clinical Orthopedic Rehabilitation (Mosby-Yearbook, 2003)