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Author Topic: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?  (Read 13853 times)

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Offline HoovSS

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I am looking for feedback from anyone who has experienced microfracture on the lateral femoral condyle or has experience with protocols for rehab of this procedure.  I am new to the knee guru and this looks like a great forum.

I had microfracture on the lateral femoral condyle of my right knee. I had an 8mm fragment of cartilage removed.  It was causing the knee to lock or give me a sharp pain.  With the microfracture, my surgeon placed only 1 pin hole in the lateral femoral condyle where 8mm fragment originated.  During the procedure, the surgeon cleaned up some rough cartilage behind the knee cap and smoothed out some small meniscal shavings for some "house cleaning" with the goal of avoiding arthritis down the line. 

ACL, MCL, PCL were all in tact with no damage or stretching.  Aside from the 8mm fragment, there were no other tears in the meniscus.  I do have chondromalacia patella.

The surgeon advised Physical Therapy right away with no restrictions.  In short, the protocol was to treat the microfracture like a scope rehab.  No restrictions on weight bearing and no Continuous Passive Motion required because there was only 1 microfracture on the lateral side (non-weight bearing side) of the knee.

I am now 19 days post-op. I have been going to Physical Therapy 3 times per week, icing 3-4 times per day and extremely diligent with home exercise and stretching.  I am able to ride a stationary bike for 15 minutes with low resistance pain free.  I also am able to swim very slowly pain free.  I can walk on flat ground without the use of a cane.  Today for the first time I was able to put enough wait on the right leg to walk up stairs. I still need the cane going downstairs and walking on declines.

I am trying to regain strength in my quads but am getting a sharp pain and dull ache in the knee when trying to do active leg extensions or straight leg lifts while lying in a prone position.  When I feel that pain I stop and go back to isometric quad setting exercises to regain strength.

Does this protocol make sense for a single microfracture on the lateral side of the knee?  Has anyone experienced this injury or protocol?  How long before you could resume basic activities like walking up and down stairs without a cane or crutches?  How long before you were able to run and resume full sporting activities?

If anyone has any insight, I would greatly appreciate it.

- HoovSS

Offline tenisfan

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #1 on: May 19, 2010, 02:17:59 AM »
i had microfractrue surgery on the same side, but with more holes. I was only on crutches for three days. Then started the rehab. Sounds exactly like yours. Give it at least a good 4- 6 months for everything to get back to normal. Yours i am sure will be sooner since you only had the one pin hole. You should be fine. I was able to walk pretty normal after about 2 months. Walking up and down stairs took a while.  Good Luck on your rehab sounds like everything is right on track. :)
2006 right knee surgery, meniscus
2008 left knee lateral release,  meniscus
2009 microfracture left knee, lateral meniscus,  fragment
2009 cartilage transplant oats
2010 loose fragment removal, meniscus fraying,found another defect
2010 oats failed, synvesic injections ,2011 right knee meniscus

Offline HoovSS

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #2 on: June 10, 2010, 03:29:37 PM »
Your advice seems right on track.  Today is exactly six weeks post-op.  I can walk up stairs unassisted but still have to be careful going down stairs.  My range of motion is back in full but atrophy in the quads is pretty extensive.  In the last few days I can now start extending my leg without pain.  I need to assist with the other foot to fully extend but it's a start.

The best thing that has helped my rehab is swimming.  The water cures all.  I have also used symphytum, a homeopathic herb that aids with bone healing.

Offline karategirl

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #3 on: June 17, 2010, 05:18:52 PM »
Hi all, I posted this over on the Knee Arthritis section of the forum and haven't gotten any responses so I figured I would try over here. My rehab sounds a lot like the two posters on here.

I am 3 weeks post op for a partial menisectomy of my medial meniscus along with microfracture of a 6mm x 4mm defect on the posterior portion of my lateral femoral condyle. My OS is a very well known and well respected doc in this area, and has worked with Olympic and collegiate level athletes, so I trust that he knows what he's doing. He's also known for his aggressive rehab following surgery and others who've worked with him have said that his aggressive approach seems to work very well in getting athletes back into action faster.

So I was partial weight bearing for 1 week after the surgery, and then allowed full weight bearing after that. I started PT the day after the surgery, where they had me doing straight leg raises, heel slides, and quad sets. About a week later, they had me doing leg presses with about 100lbs, which equates to approx 1/3 my body weight for each leg (50lb per leg, I weigh about 140lbs). I felt some sharp pain over the joint line on my lateral side, where the microfracture was performed, while doing the leg presses, but it wasn't anything agonizing. And after the session, I had only minimal swelling and some mild discomfort; no serious pains in my knee or anything.

So my question is- could I have done damage to the microfracture by doing the leg presses so soon after surgery? Or is my defect small enough that it doesn't really matter? The therapists at this place all work together with the OS, so I know they wouldn't have me doing anything that would cause damage, but I'm worried all the same because it's my first surgery and I keep reading about all these super-conservative approaches to rehab following microfracture. What are some of the tell-tale signs that I did do damage to it? I guess the fact that I didn't have lingering pain after the exercise is a good sign?

Thanks for any insight!
May 2010: Left knee partial medial meniscectomy and LFC microfracture
Dec 2010: Right knee partial medial meniscectomy

Offline HoovSS

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #4 on: June 24, 2010, 03:19:49 AM »
Karate girl -

Our injuries sound similar.  The advice I received was allow the microfracture to heal for the first 6 weeks and don't aggravate the knee.  In my case that meant only closed chain exercises (where the foot is planted firmly on the ground or on a leg press).  Open chain exercise like a straight leg raise or a leg extension were restricted for 6 weeks. I have been doing the leg press but with about half as much weight.  I weigh 170 lbs. and am using 50-60 pounds.

The highly conservative approaches to microfracture rehab are focused more on medial injuries.  We at least caught a break to have a lateral injury, which makes more aggressive recovery possible a bit sooner.

What the surgeon told me in my week 3 visit was that at 45 degrees of flexion, the knee cap glides over the lesion and can cause a sharp pain, particularly in eccentric part of exercise.  I would ask your surgeon at what part of motion does the kneecap make contact with the lesion and then protect it.  I was advised to use a cane going up and down stairs for 6 weeks and go one leg at a time to allow the microfracture in the bone to heal and max out repair of the cartilage.  THe knee takes 3 times as much force going down stairs than going up.  You don't want to leave the weak leg behind going down stairs. 

I go back to my surgeon in a few days for a 2 month post op visit.  I'm hoping to be cleared at that point to start more aggressive exercises.  The pain is manageable, but quad instability is my biggest hurdle.  I have some residual swelling but not enough to raise concern.  In another month or so, the joint should stop producing fluid.  But realistically, I am looking at another 4 months of rehab before I can start running. 

As soon as your stitches are out and your scars heal, hit the pool.  I'm not a great swimmer but I get the best workouts in the water.  You can build strength pain free since the water gives buoyancy to the knee cap avoiding contact with the healing cartilage and the microfracture.


Offline Saints21

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #5 on: June 24, 2010, 05:21:42 AM »
Hello:

I am 10 weeks post op, and my surgeon had me NBW for 2 months... Although I could do all therapy exercises with weights (the only one I am still not allowed to do is leg extensions (when you are sitting down and bend the knee until its straight?).  I am currently lifting 11 pounds on the injured leg.

I have been walking for 2 weeks my no pain (just some clicks, but me knee is still a little swollen), no pain going up or down the stairs, and I am currently doing bike for 20 minutes of resistance No. 5 (no pain)

When I was in crutches I swam every day for 20 minutes, but since I can ride the bike I am not swimming anymore

I am also doing wall squats, no pain but a little discomfort.. also I am doing one exercise where you put all your weight on your operated knee and bend it juuust a little.. again a little discomfort but no pain ...

I think its wise to rest up the joint (no weigh bearing) regardless of were the lesion is.. because in most cases you try to "fight" through the injury and aggravate it (in my MRI I also was developing tendinitis in my MCL because of all the stress I was putting on my knee)

Thats my opinion, but I am no doctor... We all should follow our doctors advised because they saw what was wrong and fixed it.

In another matter, has anyone of you started taking glucosamine?? I am gonna start tomorrow, I know the results are mixed, but it does not hurt to try to help the joint!

Good luck to all...!! I myself am very satisfied with the first stage of rehab (bring able to do everyday activities with no pain)... but I play sports so well see what happens

Offline karategirl

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #6 on: June 25, 2010, 02:27:21 PM »
Karate girl -

Our injuries sound similar.  The advice I received was allow the microfracture to heal for the first 6 weeks and don't aggravate the knee.  In my case that meant only closed chain exercises (where the foot is planted firmly on the ground or on a leg press).  Open chain exercise like a straight leg raise or a leg extension were restricted for 6 weeks. I have been doing the leg press but with about half as much weight.  I weigh 170 lbs. and am using 50-60 pounds.

The highly conservative approaches to microfracture rehab are focused more on medial injuries.  We at least caught a break to have a lateral injury, which makes more aggressive recovery possible a bit sooner.

What the surgeon told me in my week 3 visit was that at 45 degrees of flexion, the knee cap glides over the lesion and can cause a sharp pain, particularly in eccentric part of exercise.  I would ask your surgeon at what part of motion does the kneecap make contact with the lesion and then protect it.  I was advised to use a cane going up and down stairs for 6 weeks and go one leg at a time to allow the microfracture in the bone to heal and max out repair of the cartilage.  THe knee takes 3 times as much force going down stairs than going up.  You don't want to leave the weak leg behind going down stairs. 

I go back to my surgeon in a few days for a 2 month post op visit.  I'm hoping to be cleared at that point to start more aggressive exercises.  The pain is manageable, but quad instability is my biggest hurdle.  I have some residual swelling but not enough to raise concern.  In another month or so, the joint should stop producing fluid.  But realistically, I am looking at another 4 months of rehab before I can start running. 

As soon as your stitches are out and your scars heal, hit the pool.  I'm not a great swimmer but I get the best workouts in the water.  You can build strength pain free since the water gives buoyancy to the knee cap avoiding contact with the healing cartilage and the microfracture.



HoovSS-

I believe my OS said that my lesion was on the posterior part of my lateral femoral condyle, and doesn't come into contact with my kneecap at all. I was given no restrictions on either closed or open chain exercises at PT. The only thing I have been told not to do is any activities that involve impact, such as running or jumping, for at least 3 months. My rehab has been progressing pretty well. I have noticed the pain diminishing and the swelling slowly start to improve. The only real worry I had was the therapists having me do the leg presses so soon after the surgery! I see my surgeon next week for my one month follow up and will ask him about all of this.

How is your rehab going? At what point did you notice things start to really improve?

Yes, the stationary bike and pool have become my best friends these last few weeks :)
May 2010: Left knee partial medial meniscectomy and LFC microfracture
Dec 2010: Right knee partial medial meniscectomy

Offline HoovSS

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #7 on: June 28, 2010, 05:15:34 PM »
My rehab is going well.  I am 8 weeks now and my surgeon told me no restrictions going forward.  I have some residual swelling which he said is normal for the first 3 months.  It may take that long for any remaining scar tissue to break down.  For me the major improvements in rehab came in week 5 when I got full passive range of motion.  Then week 7 I was able to walk pain free without a cane but still need to be careful going downstairs and on declines - more for instability than pain.

The next goal is getting my quad and calf strength back now that all my restrictions are lifted.  The only word of caution my surgeon gave me was not to overdo it.  He sees a lot of athletic patients go back to full impact sports too soon and come back with ACL tears or MCL sprains.  Patience and persistence will carry me through to 12 weeks.

Offline HoovSS

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #8 on: June 30, 2010, 03:57:02 AM »
Saints21

Yes I have taken glucosamine prior to my surgery and have started to take it again.  I also take MSM.  The combination seems to help maintain healthy cartilage by helping it to retain water for some extra cushion.

Along the way with my recovery from surgery I used some homeopathic supplements.  Symphytum is good for healing bones and connective tissue.  Arnica is also good for healing bruising and swelling.

Leafy green vegetables like spinach and kale also offer good natural sources of calcium which can help the healing process.

Offline Saints21

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #9 on: June 30, 2010, 03:22:31 PM »
Your right... I should get some calcium suplements!!

ARINCA!!! haha My football coach always told me to take that.. now should I drink it or apply it ot the knee?

Offline alexg

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #10 on: January 24, 2012, 01:15:21 PM »
Hi everyone,

I don't know if you are still watching this board now that your probably recovered from your injury but if you are I would like to get some feedback from you on how it all turned out.  I am 1 week post op from Lateral Femoral Condyle MFX.  My ROM is excellent and have almost no swelling, and I can ride stationary bike with ease.  I am going back to see my doctor on Thursday to find out when I can ditch these crutches, hopefully it's Thursday.  Anyway if you have an good lesson's learned that you could share that would be great. 
7-4-2005 ACL rupture. 

11-9-2005 recon ACL with Achilles Allograft and meniscus fix

11-15-2007 "clean up" of scar tissue

1-17-2012 Microfracture Lateral Femoral Condyle

Offline MABoyd3

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Re: Rehab Protocol for Microfracture of the Lateral Femoral Condyle?
« Reply #11 on: April 15, 2013, 06:51:34 PM »
HoovSS/Alex G,

How are you guys making out?  I'm interested hear about your progress.

I had MFX on my LFC on 4/8, and after the first day, I virtually have zero pain and minimal swelling.  I can complete all exercises pain free and ride the stationary bike with ease. 

I was told 6 weeks non weight bearing, however I have my post op this Friday and I'm hoping to ditch my crutches as well.  I was originally told my defect was in a weight bearing area, but so far it does not seem that way.  I also had cartilage behind the kneecap shaved, however everything else was intact.
















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