Microfracture

Microfracture is performed arthroscopically. Following surgery, patients are actively encouraged to bend their knee as they feel able, as influenced by their degree of pain and swelling and on crutches for 6 weeks and follow a graduated weight bearing protocol as outlined below:

 WeekWeight Bearing
1Nil
2< 25%
325%
450%
575%
690 – 100%

Post op exercises (0 – 2 weeks)

  • Ensure you can mobilise safely on crutches
  • Circulation drills – foot pumping, static quads and glutes
  • Hamstring stretch, calf stretch with towel / rope
  • Static quads with small roll behind knee. Get VMO to fire. If VMO is sluggish then some NMS (neuromuscular stimulator) may be of benefit
  • Straight leg raise / inner range quad
  • Side leg raise
  • Reverse leg raise

As you are allowed to start weight bearing, ensure a good gait pattern and correct amount of weight (can use scales to determine this).

Review by Dr Gallagher at 2 weeks

  • A graduated progression of exercises / activity over next 2 – 4 weeks or as advised.
  • Clams
  • Calf raise

Review by Dr Gallagher at 6 weeks

  • Progression to full weight bearing with aims of normal range of motion and gait
  • Bridging
  • Squats- sit-stand (care with depth- don’t go beyond parallel)
  • Step ups
  • Band walks (tall lateral, low lateral, reverse skaters- glute drills)
  • Gait re-education
  • Proprioception
  • Bike added at 8 weeks

Review by Dr Gallagher at 12 weeks

  • Commence gym strengthening
  • Can commence running and progress to return to sport program at 16 weeks
  • If onset of reactive swelling, pain, locking, then return for review
  • Return to sport around 5 – 6 months

“Those in whom complex tears are repaired must agree to avoid strenuous activities and deep knee flexion for 4 to 6 months to prevent tear­ing and failure of the repair.” (Noyes et al 2013)

Manual Therapy

The following physiotherapy interventions may be useful in restoring the joint:

  • Patellofemoral mobilisation
  • Release / soft tissue massage lateral thigh and ITB
  • Massage of arthroscopy portals – care with depth until 4 weeks and portals healed
  • The use of NMS (neuromuscular stimulators) for VMO activation