Microfracture - rehabilitation issues

Microfracture, despite being a very simple surgical procedure to perform, requires a demanding rehabilitation. Why is this?

Microfracture is performed with a sharp awl, bent at the point. You can see an assortment of awls and the hammer at this link. The damaged area is perforated by the awl in a number of places, poking down until reaching the bone marrow, ie about half a centimetre. So it is then expected that stem cells will migrate out from the marrow, multiply and then transform themselves into fibrocartilage cells to fill the defect.

During this process the area has, by the nature of the surgery, been considerably weakened and needs protection. The only real way to protect it is to keep the patient on crutches for a period of months, and the use of crutches has to be diligent as throwing them away for even a day may undo all the good of the procedure. Crutches and non-weight-bearing produce their own set of problems, as it is important to still keep the full range of movement of the knee and build up muscle strength - so a very good rehabilitation programme is necessary.

Here is a rehabilitation protocol offered by the Steadman Hawkins clinic.

You may be interested in this thread from the knee1.com forums.

You may like to read this diary kept by a patient before and after her microfracture procedure.

Here is a whole site presented by a marathon runner who had microfracture.