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 weeks
   • Set CPM to 1 cycle per minute – range from 0–40°
   • Passive range of motion and stretching under guidance of PT
4. Therapeutic Exercises
   • 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

Phase III (Months 3-6)

1. Weightbearing: Full weightbearing
2. Range of Motion – Full / painless ROM
3. Therapeutic Exercises
   • Advance closed-chain strengthening exercises and proprioception activities
   • Sport-specific rehabilitation
   • Gradual return to athletic activity as tolerated – including jumping, cutting and pivoting sports
   • Maintenance program for strength and endurance