The increasing popularity of knee microfracturing has many patients inquiring about this unique surgical procedure. Performed in order to salvage knees with severe arthritis, microfracturing involves tiny needle punctures in the surfaces of the three bones that make up the joint surfaces of the knee: the patella, the tibia, and the femur. As a result of the puncturing, the body responds by producing a layer of scar tissue, which provides cushion in place of the missing joint cartilage. The newly formed scar tissue helps protect the knee joint from the stresses caused by walking and other everyday activities, much like cartilage would normally do.
Rehabilitation from microfracture surgery is quite different from that of most other types of knee surgery. Typically, orthopedic surgeons recommend keeping weight off the affected joint for a month or more. This tends to involve the use of crutches for an extended period of time, in order to promote scar tissue buildup, especially in the femur and the tibia. For patients who have had only the patella involved in the procedure, the surgeon may allow for weight bearing immediately after surgery, as long as the knee is not kept in a straightened position, forcing extra weight onto the patella.
Optimal success of the microfracture surgery and full recovery requires following a few simple guidelines. First, the transition to placing full weight on the knee should be gradual. Once your physician gives you permission to do so, you should place weight through the foot while allowing the crutches to still take the majority of your body weight. At first, you should walk slowly, still using the crutches, and slowly increase the amount of weight you place on the knee. This process should be gradual, over several days.
In addition to making sure the transition to allowing your affected knee to take on the full pressure of your weight, you need to keep up strength in adjacent joints. While you are not bearing weight on your knee, you can easily experience atrophy of your lower back, hip, and ankle muscles. Because these muscles will not be used during normal walking, you will need to perform exercises to maintain strength in them, or they will not be able to support you when you need them again. “Open kinetic chain” exercises are the type you need, because they do not place weight directly through the leg.
Regardless of your fastidiousness in following your physician’s rehabilitation recommendations, you will undoubtedly experience swelling around the surgery site. Antidotes to swelling include icing and elevation in the time period immediately following surgery. Following that initial period, you will do well to strengthen the VMO part of your quadriceps, since that muscle is integral to the stabilization and gliding of the patella. Both quad sets and straight leg raises can help you achieve the VMO strength you need for full recovery.
PhysioDC of Washington, D.C.
Daniel Baumstark and his professional team of physical therapists operate a boutique physical therapy office in downtown Washington, D.C. From athletes to government officials, and from ballerinas to corporate executives, PhysioDC helps people recover, strengthen and return to healthy living. Visit www.PhysioDC.com or call them at 202-223-8500.
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