Nathan WM. Skelley, M.D.

Phase I (Surgery to 2 weeks postoperative)

Appointments

• Home exercise program will begin after surgery – 2 weeks

Rehabilitation Goals

• Protect the post-surgical repair

• Restore normal knee range of motion and patellar mobility

• Eliminate effusion

• Restore leg control

Weight Bearing
Femoral Condyle Lesions

Use axillary crutches, to follow the weight bearing guidelines below. This is essential for
proper healing. For special situations and in winter months a brace may also be used.

• Weeks 0-2 = non-weight bearing

• Weeks 3-4 = touchdown weight bearing

• Weeks 5-6 = weight bearing as tolerated

Weight Bearing Patellofemoral Lesions

Use axillary crutches, in locked knee brace for 6 weeks.

• Weeks 0-3= touchdown weight bearing

• Weeks 4-6 = weight bearing as tolerated

  The surgeon may modify the weight bearing guidelines for specific situations.

Precautions

• Ambulate with crutches- weight bearing status will be discussed on an individual basis depending on location of microfracture

Range of Motion Exercises

• Knee extension on a bolster

• Prone hangs

• Supine wall slides as tolerated without pain

• Passive Range of Motion off the end of the table as tolerated

  without pain

• CPM machine

• Biking—use contralateral leg to create ipsalateral passive

  range of motion
  NOTE: Range of motion exercises should be carried out frequently throughout the day with high repetitions to help remodel the developing fibrocartilage. The optimal goal during the first 6 weeks is to do 4-8 hours of range of motion exercises per day.

Suggested Therapeutic Exercise

• Ankle pumps, isometric quadriceps sets, hamstring sets, glut sets, quad sets and patellar mobilizations

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

• Progress two weeks post-operatively

 

Phase II (weeks 2-6)

Appointments

• Rehabilitation appointments are 1-2 times per week

Rehabilitation Goals

• Protection of the post-surgical knee

• Restore normal knee range of motion and patellar mobility

• Eliminate effusion

• Restore leg control

Weight Bearing Status

• Toe Touch Weight Bearing with progression to weight bearing as tolerated at 4 weeks postoperative

Suggested Therapeutic Exercise

• Range of motion: Heel props, prone hangs, wall slides, passive ROM off table, CPM, Bike for ROM

• Range of motion exercises should be carried out for about 4-8 hours per day to help remodel the developing fibrocartilage.

• Therapeutic exercises: quad sets, SLR four directions, patellar mobilizations, gait training as appropriate,

Cardiovascular exercise

• Upper body circuit training or UBE

Progression Criteria

• Progress 6 weeks post-operatively

• No effusion

• Full knee extension

 

Phase III (6-12 weeks post-operatively)

Appointments

• Rehabilitation appointments are once every 1-2 weeks

Rehabilitation Goals

• Single leg proprioceptive control

• Normalize gait

• Muscular control with functional movements

Precautions

• Avoid post-activity swelling

• Avoid deep flexion activities

• Avoid high impact activities

Suggested Therapeutic exercises

• Non-impact balance and proprioceptive training

• Stationary bike

• Gait training

• Hip and core strengthening

• Closed chain quad strengthening

Cardiovascular exercise

• Upper body circuit training or UBE, non-impact lower body exercises including bike, elliptical, swimming

Progression criteria

• Normal gait mechanics without crutches

• Full range of motion

• No effusion

 

Phase IV (12 weeks post-operative)

Appointments

• Rehabilitation appointments are once every week

Rehabilitation Goals

• Proprioceptive and muscular control with work and sport specific activities

Precautions

• Post activity soreness should resolve in 24 hours

• Avoid post activity swelling

• Avoid knee pain with higher impact activities

Suggested Therapeutic exercises

• Impact control exercises

• Movement control exercises

• Sport/work specific drills

• Hip and core strengthening

Cardiovascular exercise

• Replicate sport/work

Return to sport/work criteria

• Dynamic neuromuscular control with multi-plane activities, without pain, instability or swelling

• Physician and rehabilitation specialist approval.