Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.
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Knee · Cartilage

Microfracture / OATS — Femoral Condyle

Post-operative protocol · Dr. Chris Vasileff, MD
For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

Femoral Condyle Microfracture/OATS/MACI/Joint Restoration Rehabilitation Protocol

Phase I – Maximum Protection (0 to 1 week):

0 to 1 week:

  • Ice and modalities to reduce pain and inflammation
  • Use crutches non-weight bearing for 2 weeks, PWB 50% for 2 weeks, progress towards FWB by 6 weeks
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility drills
  • Begin full passive/active knee range of motion exercises
  • Quadriceps setting focusing on VMO restoration
  • Blood flow restriction therapy to maintain muscle mass and activate quads
  • Multi-plane open kinetic chain straight leg raising
  • Gait training with crutches

Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 6):

Weeks 1 to 6:

  • Maintain program as outlined in week 0 to 1
  • P/AROM Start week 3 and advance 5°/Day as tolerated on CPM
  • Continue with modalities to control inflammation
  • Initiate global lower extremity stretching program
  • Begin stationary bike when 90° PROM knee flexion achieved

**Can substitute 1 hour of bike (well leg active & operative knee passive) for 2 hours of CPM**

  • Begin Pool Exercise Program when incisions healed
  • Implement reintegration exercises emphasizing core stability
  • Begin closed kinetic chain multi-plane hip strengthening on uninvolved side
  • Manual lower extremity PNF patterns
  • Proprioception drill emphasizing neuromuscular control
  • Begin multi-plane ankle strengthening

Phase III – Strengthening and Proprioceptive Phase (Weeks 6 to 10):

Weeks 6 to 10:

  • Normalize gait pattern
  • Advance stationary bike program; begin treadmill walking and elliptical trainer; avoid running and impact activity
  • Initiate closed kinetic chain exercises progressing bilateral to unilateral
  • Initiate proprioception training

Phase IV – Advanced Strengthening and Initiation of Plyometric Drills (Weeks 10 to 20):

Weeks 10 to 16:

  • Initiate gym strengthening-beginning bilateral progressing to unilateral

Leg press, heel raises, hamstring curls, squats, lunges,

Weeks 16 to 20:

  • Continue with advanced strengthening
  • Begin functional cord program
  • Begin pool running program progressing to land as tolerated

Phase V – Return to Sport Functional Program (Weeks 20 to 24):

  • Follow-up examination with physician
  • Implement sport specific multi-directional drills and bilateral plyometric activity progressing to unilateral as tolerated
  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Sports test for return to play

RETURN TO ACTIVITIES

Running: 4-5 months when functional criteria are met

Golf: Short irons at 4 months, full swing with long irons at 5 months.

Delay 4-6 weeks if lead leg.

Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically

6+ months at earliest

**Assure patient that improvement will continue to be noticed for 12 to 18 months as the new cartilage remodels and matures**

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.