Physical Therapy Exercises After Knee Microfracture Surgery

Rehab After Joint Cartilage Repair

If you have had microfracture surgery on your knee, you may benefit from physical therapy to help you fully recover. The foundation of your rehab after knee microfracture surgery should be exercise. Active and passive exercise can ensure the muscles that support your knee (and entire lower extremity) are working properly. That way you can quickly return to your previous level of function.

After microfracture surgery, you may benefit from physical therapy for rehabilitation. Your physical therapist (PT) will work with you after knee microfracture surgery to improve your knee range of motion, strength, and overall function. Your PT can provide strategies to decrease pain and swelling and help you return to normal walking and running.

What Is Microfracture Surgery?

Microfracture surgery is a procedure done to correct problems with the articular cartilage of your knee. The procedure is performed by making tiny drill holes through damaged cartilage and into the underlying bone of your knee joint. Small "cartilage clots" then form, and those clots heal and create a smooth surface on your knee's cartilage. The surgery is typically performed as an arthroscopic procedure.

Any condition that causes damage to the articular cartilage of your knee may benefit microfracture surgery. This may include:

A simple X-ray done by your surgeon can determine if the cartilage in your knee is torn or worn enough for microfracture surgery. Magnetic resonance imaging (MRI) may also be done prior to surgery to assess the cartilage damage and to see if other problems, like a ligament or meniscus tear, may also be affecting your knee.

Surgery is usually performed as an outpatient procedure. You will go home the day of surgery to begin your recovery. Your surgeon will have you follow up at regular intervals to check on your progress. Within a few weeks after microfracture surgery, you may be able to start physical therapy.

Physical Therapy After Microfracture Surgery

After microfracture, your PT can evaluate your condition and prescribe treatments that can help decrease pain and swelling and improve knee and lower extremity strength and motion. Treatments after microfracture may include:

Typically, exercises after knee microfracture surgery start within the first week or two following surgery. They progress for eight to1 2 weeks or until you have regained full mobility and functional use of your knee.

Exercise should be your main tool to use during the recovery process after knee microfracture surgery. Exercises should be started gradually with a focus on basic motion and strength. As your recovery and rehab progress, you can perform higher-level activities until you can return to your full function. Your PT can guide you along the way.

An exercise program similar to this one may be what your PT prescribes after knee microfracture surgery. Do not do any exercise until instructed by your physician or physical therapist, and stop any exercise that causes pain in your knee.

1

Knee Range of Motion

knee bend range
Jan-Otto / Getty Images

Gaining and maintaining knee range of motion after knee microfracture surgery is a priority. After the surgery, motion of your knee joint helps to keep the joint surfaces gliding and sliding past one another. This gentle motion keeps the joint surfaces smooth, and provides stimulation to the healing cartilage clots.

Your physician may have you use a continuous passive motion (CPM) machine after microfracture surgery. The machine slowly and rhythmically bends and straightens your knee. This occurs passively while you simply lie down on your back.

Most protocols after microfracture surgery call for progressive range of motion. For the first few weeks, the CPM will only bend your knee about 50 degrees. By the fourth week, your knee should be bending 90 degrees on the CPM machine.

Your PT may prescribe the heel slide exercise to gently increase knee range of motion after microfracture surgery. To do this exercise:

  1. Lie on your back with your leg out straight.
  2. Place a small towel underneath your heel so it slides easily on the floor.
  3. Slowly bend your knee us by sliding your heel towards your buttocks. A gentle stretch should be felt in your knee.
  4. Once your knee is bent, hold the position for 3 seconds.
  5. Slowly return to the starting position.

If the heel slide exercise causes significant pain, stop it and check in with your PT or physician.

2

Quadriceps Setting Exercise

Photo of PT working with a man's knee.
t your knee. Colin McPhearson / Getty Images

Getting your quads to work properly after knee microfracture surgery is important to regaining normal lower extremity function. The quad set exercise is an important first step in quad strengthening. Here is how you do it:

  1. Lie on your back with your knee straight.
  2. Place a small rolled up towel underneath your knee.
  3. Gently press the back of your knee into the towel by tightening the quad muscle on the top of your thigh.
  4. Hold the quad contraction for 5 seconds.
  5. Slowly release the quad set.
  6. Repeat the exercise 15 times.

The quad set can be done several times each day to improve quad function and contraction.

3

Short Arc Quads

short arc quads
Ben Goldstein

Short arc quadriceps exercises are another great way to strengthen the quads after microfracture surgery. To perform the exercise:

  1. Lie on your back with your operative leg out straight.
  2. Place a soccer ball, volleyball, or large coffee can underneath your operative knee.
  3. With the ball under your knee, lift your heel off the ground and straighten your leg out all the way. You should feel your quad muscle contracting.
  4. Hold the end position for 3 seconds, and then slowly lower your leg down.
  5. Repeat 15 times.
4

Hamstring Sets

hamstring strain
Photo © Maridav

The hamstring on the back of your thigh bend your knee and help to stabilize your hip and knee. Hamstring sets are great to do in the initial post-operative period after microfracture surgery. Here's how to do hamstring sets:

  1. Lie on your back with your surgical leg bent about 45 degrees.
  2. Dig your heel into the floor as if you were bending your knee, but do not allow your knee joint to move.
  3. Hold the hamstring set for 5 seconds.
  4. Release the contraction and repeat 15 times.
5

Standing Weight Shifts

During the initial post-operative period, your physician may require that you do not place any weight on your leg while standing and walking. You will likely be using crutches for a few weeks after surgery.

Once you are allowed to bear weight through your operative leg, your PT may have you perform gentle weight shifts to get used to putting your weight on your leg. To do this, simply stand up with your crutches and both feet on the floor. Gently and rhythmically shift your weight to one side and then back to the other.

Your knee may feel a bit abnormal or painful as you initially start the weight shifting exercise. This is normal and should start feeling normal after a few sessions.

Perform 15 weight shifts.

6

Straight Leg Raise Progression

Straight leg raise
Ben Goldstein

Your physical therapist may have you perform a straight leg raise (SLR) progression after knee microfracture surgery. This can help to strengthen your quads, hamstrings, and gluteal muscles. To perform the straight leg raise:

  1. Lie on your back with your operative leg out straight. Your other knee can be bent about 90 degrees.
  2. Tighten your quad muscle, and slowly lift your leg up about 12 inches.
  3. Hold your leg up for 3 seconds, and then slowly lower.
  4. Repeat 15 times.

You can perform straight leg raises on your back, side, or stomach. Each position will work a different part of your hip and thigh musculature.

To make straight leg raises more challenging, you can add a 2- or 3-pound cuff weight to your ankle.

7

Balance And Proprioception

Bosu Ball
Bosu Ball. Rich Legg/E+/Getty Images

Often after lower extremity surgery, your balance and proprioception is impaired. Working on balance exercises may be a part of your rehab after microfracture surgery.

Balance exercises that your PT may prescribe may include:

  • Single leg standing
  • Single leg standing on foam or a pillow
  • Single leg stance with eyes closed
  • Using a BAPS board
  • Using a BOSU ball

Balance exercises should be challenging, but you must remain safe while performing the exercises. Be sure you can grab onto something stable when doing various balance activities.

8

Biking

Woman on a stationary bike
Caiaimage/Trevor Adeline/Getty Images

After microfracture surgery, your PT may have you ride a stationary bike. During the initial phases of the post-operative period, biking may be used to improve knee range of motion.

You may have to start out slow on the stationary bike; if your knee range of motion is limited to 90 degrees or less, you may not be able to pedal full revolutions on the bike. Simply pedal around as far as you can, and then pedal backward as far as possible. Repeat the forward and retro pedaling until you are able to make full revolutions.

As you progress in your rehab, bike riding can help improve overall cardio-respiratory endurance as well as lower extremity endurance.

9

Return to Sports

Young male soccer player kicking ball on soccer pitch
Stanton j Stephens / Getty Images

If you are an athlete, return to sports after knee microfracture surgery can occur about 12 to 16 weeks after surgery. Prior to returning to sports, your PT will likely begin high-level exercises. These may include:

The goal of return to sport exercises is to prepare your knee (and your body) to appropriately manage the high level of stresses that will be placed on you during your chosen activity. Your PT can help you decide on the right exercises and intensity for your specific condition.

A Word From Verywell

Knee microfracture surgery is performed to repair damaged cartilage in your knee joint. The surgery may cause pain, swelling, loss of range of motion, and impaired strength in your knee and leg. Working with a physical therapist can help you fully recover. Your PT can prescribe the right exercises for your specific condition so you can quickly, and safely, return to your previous level of function.

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  1. Frehner F, Benthien JP. Microfracture: State of the art in cartilage surgery?. Cartilage. 2018;9(4):339-345. doi:10.1177/1947603517700956

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