From the Guidelines
Recovery after microfracture surgery of the knee typically takes 6-8 months for complete healing, with a structured rehabilitation protocol being essential. Initially, patients should follow a non-weight bearing or partial weight bearing regimen for 6-8 weeks, using crutches as directed by their surgeon. Pain management in the first few weeks includes prescribed medications such as oxycodone/acetaminophen (Percocet) 5/325mg every 6 hours as needed for severe pain, or NSAIDs like ibuprofen 600mg three times daily with food for moderate pain. Ice therapy for 20 minutes every 2-3 hours and elevation above heart level help reduce swelling.
Key Rehabilitation Steps
- Physical therapy begins immediately after surgery with gentle range of motion exercises, progressing to strengthening exercises around week 6-8, and sport-specific activities by month 4-6.
- Continuous passive motion (CPM) machines may be prescribed for 6-8 hours daily during the first few weeks to stimulate cartilage growth.
- This gradual approach is necessary because microfracture works by creating small holes in the bone to release marrow cells that form a blood clot, which eventually develops into fibrocartilage to fill the damaged area, as seen in studies such as 1.
Considerations for Rehabilitation
Rushing the recovery process can damage this new cartilage formation and compromise surgical outcomes. While the provided studies primarily focus on hip arthroscopy and ACL reconstruction 1, the principles of gradual rehabilitation and pain management can be applied to microfracture surgery of the knee, prioritizing the patient's morbidity, mortality, and quality of life.
Rehabilitation Protocol
The rehabilitation protocol should be tailored to the individual patient's needs and progress, with regular follow-up appointments with their surgeon and physical therapist to ensure a smooth and successful recovery. By following a structured rehabilitation protocol and prioritizing gradual progression, patients can optimize their chances of a successful outcome after microfracture surgery of the knee.
From the Research
Expected Recovery after Microfracture Surgery
The expected recovery after microfracture surgery of the knee can be understood through various studies that have examined the outcomes of this procedure.
- Clinically meaningful and statistically significant improvements in patient-reported outcomes (PROs) have been observed after microfracture surgery, with improvements seen in Lysholm, International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and overall satisfaction scores 2.
- Factors such as patient BMI, age, sex, defect location, concomitant procedures, and operative side were not significant predictors for additional surgery, while larger defect size (>3.6 cm2) and prior knee surgery were independent risk factors for additional knee surgery after microfracture 2.
- Rehabilitation programs following microfracture procedures are individualized based on the nature of the lesion, patient characteristics, and surgical procedure details, aiming to restore full function as quickly as possible while facilitating a healing response without overloading the healing articular cartilage 3.
Recovery Time and Functional Outcomes
- Studies have shown that patients can experience significant improvements in functional outcomes, such as KOOS scores, after microfracture and Hyalofast grafting surgery, with improvements seen at 1,2, and 3 years post-surgery 4.
- The use of Hyaluronan (HA)-based 3-D scaffolds has been shown to result in faster recovery and improved functional outcomes compared to microfracture alone, with significant improvements in Henderson score and Modified Cincinnati Knee Rating System (MCKRS) scores at 6 months post-surgery 5.
- Athletes who undergo microfracture surgery can expect to return to sports participation, with 66% of athletes returning to sports at an average of 8 months after surgery, and 67% returning to competition at the preinjury level 6.
Factors Affecting Recovery
- Factors such as athlete's age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology can affect sports activity after microfracture 6.
- Patient-related factors, such as BMI, can also impact postoperative scores, with patients having a BMI >30 kg/m2 experiencing lower postoperative scores on the KOOS activities of daily living subscale and poorer WOMAC function and pain scores 2.