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 — Patella / Trochlea

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.

Trochlea/Patella Microfracture/OATS/MACI/Joint Restoration Rehabilitation Protocol

Phase I – Maximum Protection (0 to 6 weeks):

0 to 1 week:

  • Ice and modalities to reduce pain and inflammation
  • Brace 0° to 20° for 6 weeks
  • 50% Weight Bearing x 1 week, then WBAT in Brace.
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility drills
  • PROM 0°-60° first 2 weeks
  • 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

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 and operative knee passive) for 2 hours of CPM**

  • Begin Pool Exercise Program when incisions healed (week 3)
  • 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 16):

Weeks 6 to 10:

  • Continue with Phase II exercises as indicated
  • Begin Protected Weight Bearing Opening Brace As Follows:

- 0° to 45° (week 7)

- 0° to 60° (week 8)

- 0°to 90° (week 9)

- Wean out of brace by week 10

  • Normalize Gait
  • Advance time and intensity on cardiovascular bike program
  • May begin treadmill or elliptical trainer - avoid running
  • Initiate closed kinetic chain exercises progressing bilateral to unilateral

Weeks 10 to 16:

  • Initiate gym strengthening – bilateral, progressing to unilateral as tolerated
  • Leg press, squats, hamstring curls, ab/adduction, calf raises
  • Avoid leg extensions/lunges
  • Begin functional cord resistance program

Phase IV – Advanced Strengthening (Weeks 16 to 20):

  • Continue with a full gym-strengthening program avoiding PF provocative exercise (lunges, leg extensions…)
  • Begin pool running program advancing to an interval running program
  • Initiate Impact Activity (As Directed by Physician)

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

  • Follow-up examination with physician
  • Implement sport specific multi-directional drills
  • Continue with aggressive lower extremity strengthening, cardiovascular training, and flexibility
  • Continue with plyometric activity (increasing as tolerated)
  • 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.