Microfracture of the Patellofemoral Joint +/- BioCartilage Rehab Protocol

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Phase 1 (0-6 weeks)

  • Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
  • Modalities: Compressive cyrotherapy, e-stimulation
  • Weightbearing: May begin weight bearing with hinged brace locked in extension, using crutches
  • Brace:
    • Locked in extension full-time 24 hours per day for initial 48 hours.
    • After 48 hours begin progressive ROM for exercises.
    • Brace locked at all times weight bearing.
  • ROM:
    • Initial 0-2 weeks: 0-30°
    • Weeks 2-4 advance to 0-60°
    • Weeks 4-6 advance to 0-90°
  • Exercises:
    • 0-2wks: Quad sets, SLR, calf pumps, passive leg hangs to 45deg at home
    • 2-6wks: PROM/AAROM to tolerance, patella and tibiofibular joint mobs, quad, hamstring, and gluteal sets, SLR, side-lying hip and core

Phase 2 (6-8 weeks)

  • Weightbearing: Full
  • Brace: Begin to wean from brace after 6 weeks. Advocate to continue in uncontrolled settings or adverse weather.
  • ROM: Full 0-120°
  • Exercises: Advance Phase 1 exercises. Progress weightbearing flexibility, begin toe raises and closed chain quad work. Begin floor-based core and glutes work, balance exercises, hamstring curls and stationary bike

Phase 3 (8-12 weeks)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Gait training, begin closed chain activities: wall sits, shuttle, mini-squats, toe raises. Begin unilateral stance activities, balance training.

Phase 4 (12wks – 6mo)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Progress phase 3 exercises: maximize core/glutes, pelvic stability work, eccentric hamstrings. May advance to elliptical, bike, pool as tolerated.

Phase 5 (6-12 months)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Advance functional activity. Return to sport-specific activity and impact when cleared by MD after 8mo.