Postoperative Management After Osteochondral Fragment Fixation and MPFL Reconstruction
Begin immediate range of motion within the first postoperative week rather than immobilizing for 4 weeks, as early mobilization improves outcomes without compromising stability or fixation.
Immobilization Strategy
Avoid prolonged immobilization with a knee immobilizer for 4 weeks. The evidence strongly supports early mobilization:
Immediate knee mobilization (within 1 week) should be initiated following knee ligament reconstruction procedures 1. Multiple high-quality guidelines from the British Journal of Sports Medicine demonstrate that immediate mobilization improves early-phase knee flexion and extension range of motion without compromising knee laxity, regardless of graft type 1.
Postoperative knee braces should not be routinely used 1. The consensus across multiple guidelines (NZGG, DOA, MOON, AAOS) indicates that routine postoperative functional knee bracing is not recommended, with use limited only to patient preference or associated ligament injuries 1.
For osteochondral fixation specifically, overly aggressive immobilization may increase stiffness risk, while early motion is essential to prevent complications 1. However, the key caveat is avoiding overly aggressive physical therapy that may increase fixation failure risk 1.
Range of Motion Protocol
Initiate passive range of motion immediately postoperatively with the following structured approach:
Begin passive ROM exercises within the first postoperative days 1. Early finger and joint motion is essential to prevent edema and stiffness after surgical fixation 1.
Isometric quadriceps exercises (static contractions and straight leg raises) should be prescribed during the first 2 postoperative weeks 1. These confer advantages for faster recovery of knee range of motion at 1 month without compromising stability 1.
Progress to closed kinetic chain exercises starting at 3 weeks postoperatively 1. Leg press exercises at 3 weeks can improve subjective knee function and functional outcomes 1.
Continuous passive motion (CPM) may be used in the immediate postoperative period 1, though one guideline recommends against routine use 1.
Weight-Bearing Protocol
Allow early weight-bearing as tolerated:
Immediate or early weight-bearing (within 1 week) should be initiated as tolerated 1. Multiple guidelines support immediate full weight-bearing following knee reconstruction procedures without compromising outcomes 1.
Recent evidence from combined MPFL reconstruction with osteochondral procedures shows initial restrictions in weight-bearing are common in early rehabilitation phases 2, with earlier full weight-bearing after surgical reconstruction compared to conservative treatment 2.
Specific Considerations for This Case
For the 18-year-old with combined osteochondral fragment fixation and MPFL reconstruction:
The quadriceps tendon MPFL reconstruction technique has distinct advantages, including preventing chondral overloading and non-violation of patellar bone 3. This approach with combined osteochondral fixation demonstrates good patient-reported outcomes with low recurrent instability rates 3.
Monitor for anterior knee pain as load is progressed, particularly with closed kinetic chain exercises 1.
Avoid open kinetic chain exercises until at least 4 weeks postoperatively (90-45° range) 1, as these may induce more anterior knee pain 1.
Critical Pitfalls to Avoid
Do not immobilize for 4 weeks - this contradicts current evidence-based guidelines and increases stiffness risk without improving stability 1.
Avoid overly aggressive physical therapy that may compromise fixation integrity, particularly in the first 6 weeks 1.
Balance early mobilization with protection of the osteochondral fixation - while immediate ROM is recommended, the intensity must be carefully controlled to prevent fixation failure 1.
Ensure correct patellofemoral tracking was achieved intraoperatively, as this is the pivotal step determining functional outcomes 4.