Microfracture of the Femoral Trochleapatellar Defect

Phase I (Weeks 0-8)

1. Weightbearing:  Weightbearing as tolerated in hinged knee brace locked in extension
2. Hinged Knee Brace:  Locked in extension for ambulation – opened up 0-40° for ROM exercises
3. Range of Motion – Continuous Passive Motion (CPM) Machine for 6-8 hours per day for 6-8 weeksSet CPM to 1 cycle per minute – range from 0-40°Passive Range of Motion and stretching under guidance of PT
4. Set CPM to 1 cycle per minute – range from 0-40°
5. Passive Range of Motion and stretching under guidance of PT
6. Therapeutic ExercisesQuadriceps/Hamstring isometrics 
7. Quadriceps/Hamstring isometrics 

Phase II (Weeks 8-12)

1. Weightbearing:  Advance to full weightbearing as tolerated — discontinue crutch use
2. Discontinue Use of Hinged Knee Brace
3. Range of Motion – Advance to full/painless ROM (PROM/AAROM/AROM)
4. Therapeutic Exercises- Emphasize Patellofemoral Program- Closed chain extension exercises- Hamstring curls- Toe raises- Balance exercises- Begin use of the stationary bicycle/elliptical
5. Emphasize Patellofemoral Program
6. Closed chain extension exercises
7. Hamstring curls
8. Toe raises
9. Balance exercises
10. Begin use of the stationary bicycle/elliptical

 Phase III (Months 3-6)

1. Weightbearing:  Full weightbearing
2. Range of Motion – Full/Painless ROM
3. Therapeutic ExercisesAdvance closed chain strengthening exercises, proprioception activitiesSport-specific rehabilitationGradual return to athletic activity as tolerated – including jumping/cutting/pivoting sportsMaintenance program for strength and endurance
4. Advance closed chain strengthening exercises, proprioception activities
5. Sport-specific rehabilitation
6. Gradual return to athletic activity as tolerated – including jumping/cutting/pivoting sports
7. Maintenance program for strength and endurance