April 2011

Rehabilitation following microfracture surgery

Much of the success of microfracture surgery for articular cartilage lesions in the knee depends on what happens after the surgery is over. Progressive, controlled loading of the repaired joint is the key to safe and effective rehabilitation.

By Jon Fravel, ATC, and Michael Shaffer PT, ATC, OCS

Injuries to the articular cartilage of the knee are serious, with potentially debilitating consequences if not managed appropriately. Articular cartilage injuries can occur from either an acute traumatic event or from chronic degeneration.1 Acute traumatic injuries producing cartilage lesions are most often seen in a younger athletic population, while chronic degenerative lesions most often occur in older individuals. Articular cartilage injuries are diagnosed both by clinical exam and imaging. A positive clinical exam includes mechanical symptoms of clicking, popping, catching, effusion and warmth.

Cartilage lesions occur across a spectrum of injury. Outerbridge classification defines these as normal cartilage (grade 0), softening (grade 1), fibrillations (grade 2), fissuring (grade 3), and exposed subchondral bone (stage 4).2 Articular cartilage injuries resulting in full thickness defects to the subchondral bone have been shown to have poor healing without surgical intervention.3-5 As surgical technology has evolved, new techniques to address chondral defects have appeared. Surgical techniques fall into several broad categories:  marrow stimulation, grafting, and autologous chondrocyte implantation (ACI). Microfracture, drilling, and abrasion arthroplasty are considered marrow stimulation techniques, whereas grafting includes both osteoarticular transfer system (OATS) and mosaicplasty.

Among the different surgical techniques available to address the articular cartilage of the knee, microfracture is generally considered to be the least invasive.6,7 Use of this surgical technique does not affect the surrounding anatomy of the knee, so that other techniques, such as grafting, could still be attempted should microfracture fail. This technique removes loose cartilage flaps followed by debridement of the walls of the lesion with the calcified cartilage removed down to the bony base. A microfracture awl perforates the subchondral bone to a depth of approximately 2 mm to 3 mm to induce bleeding. These perforations are separated by 2 to 4 mm. Bleeding and fat droplets are observed arthroscopically if the technique has been performed correctly. This bleeding creates a clot that will develop into the new fibrocartilage base.5,8

Appropriate candidates for microfracture surgery have been defined as young individuals with isolated lesions, no degenerative changes, and normal knee alignment. Microfracture should not follow previous surgical techniques used to repair the cartilage lesion. This treatment should not be used if there is subchondral bone loss, malalignment, other degeneration, or if the patient is suspected of being non-compliant with post-operative protocol.4,8,9

Figure 1. Unstable platform bilateral squatting.

In recent years, microfracture has come to the attention of the lay public as it has been successfully used on several high profile athletes. Despite the fact that these athletes have been able to fairly quickly and successfully return to competition following microfracture, it is our belief that articular cartilage is a vital tissue for joint health, and that surgical procedures and subsequent rehabilitation techniques to address articular cartilage injuries should be regarded as serious undertakings. Although microfracture is often the first surgical choice for small, full thickness articular cartilage injuries, articular cartilage lesion healing is a difficult process and these cases should be advanced cautiously through the rehabilitation process. The rehabilitation protocol utilized at our institution and outlined in the section that follows has been adapted from that described by microfracture pioneer Richard Steadman,MD, and colleagues.10

Phase I (0-6 Weeks): Immediate post-operative care

The patient typically spends the first six weeks after microfracture on crutches, either non-weight bearing or toe touch weight bearing. Because the success of this procedure relies on the formation of a blood clot at the site of the defect, protection of the clot is paramount during this early time frame. The use of a continuous passive motion device (CPM) as a tool to assist nourishing the surrounding articular cartilage is commonly advocated.4,8,9,11-13 In the only trial investigating the use of CPM after microfracture, there was no difference in the amount of improvement, as measured by Lysholm outcome scores, between those patients who used a CPM and maintained non-weight bearing (NWB) status for the first six weeks and those patients who were allowed to bear weight as tolerated and didn’t use a CPM device.14 In our practice, a CPM is not routinely ordered for patient use at home. Instead patients are encouraged to perform a regular program of non weight-bearing, active assisted range of motion (ROM) activities. Home exercises are supplemented with the use of stationary bicycle or aquatic ROM exercises when patients come to the physical therapy clinic or athletic training room.

Figure 2. Resisted side lunging.

It is also crucial during this first phase of rehabilitation to maximize lower extremity strength and quadriceps function in particular. A strong, well functioning quadriceps muscle appears to be beneficial for healing of the fibrocartilaginous clot by absorbing ground reaction forces, which would otherwise be partially borne by the joint surfaces. However, maximizing quadriceps function in this early post operative period often proves to be a more difficult task than expected, since the patient is nonweightbearing. Therefore, the rehabilitation specialist must try to maximize quadriceps function through the use of exercises such as quadriceps sets, hip flexion straight leg raises, and/or open kinetic chain knee extension exercises. It is important to remember that if microfracture is performed on the patellar undersurface or trochlea of the femur, the clinician must be more cautious about the amount of load placed on the quadriceps as that force will be transferred through the patellofemoral articulation. In contrast, if microfracture is performed on the femoral condyles, there is no particular restriction to the use of progressive loading of the quadriceps muscle or the use of electrical stimulation if quadriceps inhibition is clinically obvious.

Phase II (6-12 weeks): Progressive strengthening and loading

The second phase of rehabilitation is marked by the gradual addition of weight bearing forces. At the two-week post-operative physician visit, many patients are measured for an unloader brace. If the patient lives at a distance or for some other reason has not already picked up this brace, the brace is typically dispensed at the six-week post-operative visit with the surgeon. At that visit, the patient is also counseled on the process to gradually wean themselves off the crutches.

Because articular cartilage is relatively aneural, pain level cannot be used to guide rehab progression, so it is important to remind the patient to use joint effusions and general knee discomfort as a guide for the progression of their weight bearing. The balancing act between appropriate progression and overloading the joint is a theme that will be repeated over the remainder of the rehabilitation period.

In order to progress from non-weight bearing to full weight bearing, the athlete must have well controlled joint effusion, maintenance of range of motion gains, and the absence of a limp. Sequentially, the patient progresses from bilateral axillary crutches to a contralateral axillary crutch and finally to full weight bearing without the use of an assistive device. If the patient is struggling with the progression to weight bearing, aquatic therapy and water walking can be very beneficial. The clinician is reminded that because of the buoyancy effect of the water, the amount of weight bearing progressively decreases as the percentage of the body is submerged.15

Figure 3. Unstable platform bilateral squatting with perturbation.

In the rehabilitation clinic, devices such as a leg press machine can serve as a transition between Phase I non-weightbearing isotonic machinery (knee extension and knee flexion hamstring curls) and closed chain, weight bearing exercises such as squats, step ups, lunges, etc. which are the hallmark of Phase II.  The clinician has at his or her disposal the progression from bilateral to unilateral, progressive range of motion (progressive depth), and the addition of external weight as a means to progressively challenge the patient and load the joint surfaces. Conversely, the rehabilitation specialist can alter any of these factors as a means to unload the joint surfaces if the patient does demonstrate a joint effusion or other negative responses. In our practice, non-weightbearing exercises such as the straight leg series and open chain isotonic machines in Phase I are typically performed without the unloader brace, while weight bearing exercises in Phase II are typically performed with the use of the brace to help unload the repaired area.

Phase III (12-24 weeks): Neuromuscular retraining

The primary goal of the third phase of rehabilitation is to normalize neuromuscular function. This requires progressive strengthening with continuation of Phase II activities. But Phase III is also characterized by the addition of unstable surfaces and simulated sport activities to provide progressive neuromuscular challenges for the athlete (Figures 1a, 1b, 2, and 3). For instance, the basketball player must be prepared for return to competition through progressive jumping and cutting activities.

Given the importance of progressive but controlled joint loading, it is important to examine jumping more closely. Jumping imparts joint loading forces equal to 12 times body weight.16 Forces less than 12 times body weight can be imparted by jumping “up” onto a box, jumping in water, or jumping on a commercial device that simulates a leg press but utilizes elastic resistance. If the athlete is able to tolerate these forces without the development of joint effusions, progressive loads can be applied by changing the resistance of the commercial device, changing the level of the jumps (from initially jumping up, to level jumping [broad jumps], and finally jumping down from a height). The clinician can also control joint forces by progressing from bilateral to unilateral jumps on the affected limb. Table 1 outlines this jumping progression. Continuing with the example of the basketball player, each of these stages can be made more challenging from a neuromuscular standpoint by adding ball tossing activities or simulated rebounding drills.

Phase IV(> 24 weeks): Return to activity

The final phase of rehabilitation is return to activity. This is accomplished by gradually introducing the athlete into partial practices or team conditioning drills. If not already taking place, participation in team strength training sessions is a safe reintroduction to team activity. As the athlete starts to return to practice, drills involving straight ahead jogging are added first, taking care to avoid contact with a teammate or any changes of direction.  If a brace is being worn at this point, which is optional, the brace may help protect the joint in addition to its intended function of unloading. Gradually the athlete is permitted to change direction, and sequentially take part in drills involving jumping, and finally contact with an opponent. Table 2 outlines the postoperative rehabilitation protocol detailed above.

As always, the presence of a knee effusion indicates that the joint is being negatively stressed with the addition of these progressive loads. “Rest days” or returning to the previous level of loading for a period of time should be utilized as needed. In the absence of effusion, athletes should be training at least twice a week at this stage, depending on their skill level. If the athlete is unable to resume impact activities for a prolonged period, the joint surfaces can be re-evaluated for gross macroscopic changes with a repeat MRI.

Conclusion

In summary, microfracture and the rehabilitation following this surgical procedure remain relatively new. Rehabilitation of athletes following microfracture requires knowledge of the goals of the procedure and patience on the part of the athlete and the rehabilitation specialist. The rehabilitation clinician must understand the process of progressive, controlled joint loading. The athlete must develop adequate strength and neuromuscular control to contend with joint stresses. Finally, the rehabilitation specialist needs to be vigilant about examining for joint effusions as progressive joint loading forces are applied, since effusions are an important marker of excessive joint stress.

Jon Fravel ATC is a certified athletic trainer at the University of Iowa in Iowa City. Michael Shaffer PT, ATC, OCS, is the Coordinator for Sports Rehabilitation at the Institute for Orthopaedics, Sports Medicine and Rehabilitation at the University of Iowa.

References

1. Blevins FT, Steadman JR, Rodrigo JJ, Silliman J. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics 1998;21(7):761-767.

2. Outerbridge RE, Dunlop JA. The problem of chondromalacia patellae. Clin Orthop Rel Res 1975;(110):177-196.

3. Buckwalter JA. Articular cartilage: injuries and potential for healing. J Orthop Sports Phys Ther 1998;28(4):192-202.

4. Steadman JR, Briggs KK, Rodrigo JJ, et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 2003; 19(5):477-484.

5. Steadman JR, Rodkey WG, Singleton SB, Briggs KK. Microfracture technique for full-thickness chondral defects: technique and clinical results. Operartive Tech Orthop 1997;7(4):300-304.

6. Gomoll AH, Farr J, Gillogly SD, et al. Surgical management of articular cartilage defects of the knee. J Bone Joint Surg 2010;92(14):2470-2490.

7. Mithoefer K, Hambly K, Della Villa S, et al. Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 2009;37(Suppl 1):S167-S176.

8. Sledge SL. Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med 2001;20(2):365-377.

9. Assche DV, Caspel DV, Staes F, et al. Implementing one standardized rehabilitation protocol following autologous chondrocyte implantation or microfracture in the knee results in comparable physical therapy management. Physiother Theory Pract 2011;27(2):125-136.

10. Hurst JM, Steadman JR, O’Brien L, et al. Rehabilitation following microfracture for chondral injury in the knee.  Clin Sports Med 2010;29(2):257-265.

11. Yen Y, Cascio B, O’Brien L, et al. Treatment of osteoarthritis of the knee with microfracture and rehabilitation. Med Sci Sports Exerc 2008;40(2):200-205.

12. Kon E, Gobbi A, Filardo G, et al. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 2009;37(1):33-41.

13. Nho SJ, Pensak MJ, Seigerman DA, Cole BJ. Rehabilitation after autologous chondrocyte implantation in athletes. Clin Sports Med 2010;29(2):267-282.

14. Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy 2005;21(2):152-158.

15. Prins J, Cutner D. Aquatic therapy in the rehabilitation of athletic injuries. Clin Sports Med 1999;18(2):447-461.

16. Panzer VP, Wood GA, Bates BT, Mason BR. Lower extremity loads in landings of elite gymnasts. In: DeGroot G, Hollander AP, van Ingen Schenau GJ, eds. Biomechanics XI-B. Amsterdam: Free University Press; 1988:727-735.

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44 Responses to Rehabilitation following microfracture surgery

  1. Dace Mowry says:

    Two and a half months ago I had acl/miniskus/large microfracture. I am still having some pain and stiffness after a day at work as an electrician. I have been taking it really easy when there,should I be up on my feet for long periods.

  2. Owen Parr says:

    I have no had 2 surgeries on my left knee to repair a meniscus tear both times. During the second procedure they preformed microfracture surgery and I am now 8 months post surgery. I have had a great recovery and have worked diligently with an athletic trainer to strengthen my legs as that was one of the main things my OS and Sports Medicine therapist told me. I am an avid basketball junkie and recently began playing again. I limited the number of days a week I played and the number of games and had been feeling great; until this Tuesday. This Tuesday I played half court and played several games and as always post workout or when I finish playing I iced my knee. Well since Wednesday morning I am limping as if I had surgery yesterday. My biggest pain is in the area where they drilled and specially when I straighten my leg. I will be walking and all of a sudden I get this intense sharp pain in that specific area. Has anyone had this occer, can you explain what it might be and what I can do without having to return to my OS? I appreciate any advice or feedback you can provide. I guess the only advice I really don’t want to hear is to stop playing basketball. I am 47 and it truly is one of those things I really still enjoy and at a pretty competitive level. Thanks in advance!

  3. jack says:

    yep i have that same shooting pain once in a while and I can hardly walk. The micro surgery is over rated for older patients. My doctor did it without even discussing the procedure with me. I was supposed to walk out of the office but instead on crutches for two weeks. Now six weeks and in worse shape then before the surgery. I would not recommend the procedure.

  4. Renee Foster says:

    I am 33yr old women I had surgery when I was 14 then 15 to remove cartilage, I have developed traumatic osteoarthritis. As a solution to my knee problems I had microfracture Nov 2011 my recovery was good for a while , Feb , and March I had been able to get back in to spinning, and was progressing back to my 20 k. Then it just started to get more and more iritable til my physio said that we would have to go to stepups on a phone book, how lame even that was too iritable. I had a cortisone injection to calm it down, holy moly that just made it worse I couldnt walk for a week which was weird cause the first injection was wonderfully helpful. My knee is now catching popping hurting chronically. I cant carry the groceries with out buckling and am sick of it. I would say this hasn’t worked for me. I am currently waiting to see the surgeon again.

  5. Kate says:

    I had a micro fracture surgery on 11/12/12. 2 weeks post surgery, I was instructed to weight bare and not use crutches. The night of my surgery, I walked a few steps and had this hard buckling feeling in my knee.( feels like when someone walks up behind you and knees you in the back of the knee and you lurch forward) I began using my crutches on my own and limiting the weight i put on the left leg. My post op appt the PA i saw gave me a new knee brace w hinges on the sides and said things should get better once i strenghten my knee. Tonight i had a episode of the buckling, and now there is sharp stabbing pains in my knee that feels like someone is driving a steak knife thru it. Has anyone experienced this buckling problem and if so how did you get rid of it so to speak.

  6. Paul says:

    Kate, I had micro fracture surgery and a new acl put inand meniscus work done, I had buckling on occasion several weeks after. It took a wile to strengthen with yoga, weights and swimming as well as losing some weight but it is better. Give it time and listen to the physician. If it does not go away after you gain strength there is a problem but given it time. I no longer use the brace working out.

  7. carolyn says:

    I had microfracture on my knee 6 weeks ago. I went home after surgery without crutches, andcwasxtold I was weight bearing!! Luckily I had crutches in my attic. Ther was no way that I could walk without them. Everything I have read, says that you are not supposed to bear weight for 6 weeks! I have been bearing weight right frim the start!
    I have full range of motion. I have a clicking feeling in my knee if I am standing still, and I shift my weight from one foot to the other. Periodically I get a stabbing pain right above my knee cap. I feel like I have a bruised knee.
    The dr is a complete ass. At my 4 week follow up I expressed my disgust. He offered me a shot! He said it would speed recovery! I did not do it! I want to know why it hurts more now, then before surgry?!
    Dont do it! Big mistake! Iwould give anything to just go back to the discomfort I had prior to surgery!
    I am 42.

  8. mike says:

    I’m 48 years old, I used to say 48 years young but thats changed. I had meniscus removal, bucket tear to medial meniscus & microfracture to trochlear, groove on femur that patella rides on during flexion. Surgical date was this past July. Worked hard to rehab but got an awful start due to poor rehab protocol from OS & uniformed PT. My fault too, I should have educated myself better. I’m able to walk comfortable but any additional load causes stabbing pain mentioned in some of the posts listed. My knee needs movement or stiffness occurs. I’m beggining my info quest on what may be next to get my athletic life back. ACI surgery is one option but apprehensive due to invasive procedure. Surgery requires “open knee” meaning cut the patella-femoral tendon. Has anyone out there had this procedure, need feedback please.

  9. carolyn says:

    I feel for you Mike. I was in the best shape of my life prior to this surgery. This has been a very humbling experience for me. I too, wish I had better educated myself. I feel like I am the main person to blame here. That in itself is maddening!
    I honestly think I didnt even need surgery. I have battled pain behind my knee, on and off for a couple yrs. Last summer I went for a run and the pain was horrible! My knee swelled, and I was miserable for a good month. That is what sent me to the dr for the hundreth time. They did an MRI and it showed 2 cysts behind my knee, and a torn meniscus. It made sense to me that I had pain behind behind the knee. Surgery seemed like the answer. Once they got in there the meniscus was not torn. Why he did microfracture I do not know.
    I went to a chiropractor yesterday. Boy do I wish I went there first! My pelvis is higher on one side than the other. My gait is totally off. My IT band and hamstring on the bad leg are both really tight. He thinks that my gait is what caused the arhritis in the knee. I am really hoping that working with him and my pt will get me back to the fit lifestyle that I am used to.
    Sorry for the long post. It feels good to purge my frustration. Good luck with your road to finding your old athletic self.

  10. Gr e et says:

    I had a Acl replacement a meniscus tear and a microfracture this injury happend November 3rd playing soccer with my kids. November 21 st i had surgery a new Acl miniscus could not be fixed torn by the bone so got cleaned up and i got the microfracture drilling the wholes. Now more than 2. Months further still have lack of motion and pain . Walking on crutches going to PT 2. X a week and doing excersises every day at home. I have not slept a night thru sinds this injury happend it has been a long road and still a long road to recovery . I long to be able to walk again but am also afraid to do so.

  11. SK says:

    I have had ACL reconstruction on both knees, one 19 and one 18 years ago. The Left (18 years ago) failed again after tripping and landing badly. No cartilage tears were apparently on the MRI pre-op. Once in surgery, there were several major tears (which treatment was not discussed regarding considering no tears were suspected) and microfracture was done. I had microfracture done on my ankle 3 years ago, and I am NOT a big fan of because of the increase in pain, however, I have found no valid alternative to date. In the ankle, post-op (couldn’t walk at all for 3 1/2 months) had much more stability than prior to surgery, but extreme increased pain. Received a 3-series shot of synvisc. Saved my life. Mo more pain in ankle almost immediately after finishing the series.

    The first 2 ACL reconstructions, I had buckling that felt like my leg was going to separate. No cartilage tears at that time. This time, I didn’t hesitate to complete the ACL reconstruction, as I knew my knee would get much weaker and the recovery would be harder too. So I had the repair and microfracture 2 weeks post-injury. None weight bearing for 2 weeks, then about 40lbs of pressure with crutches for 4 weeks. I am almost 4 weeks post-op now and I am being very aggressive with PT, although strengthening the quad is not as productive as I would like to see. I have learned through my experience and research, that the idea behind the microfracture is to increase blood flow to the cartilage and to cause scar tissue to form in the areas where the cartilage has been damaged. It hurts because it order to reach the area where the cartilage attaches…or the root, the drilling has to go into the bone to reach fresh blood. This takes a long time to heal and may leave nerve ending exposed that need to be healed over…thus more pain.

    I can feel that my knee is much stronger than even before the complete tear this time. This ACL reconstruction was done as arthroscopy and an open procedure due to the drilling and the removal of the old graft and the placement of the new with anchors. The healing of that part is VERY minimal. If I put too much weight on my leg, I do get some shooting pains. I find that following weight bearing restrictions, elevation and ice on a regular basis, with the aid of antiiflammatories and aggressive PT have limited that occurrence to maybe once in the last 10 days. I can feel much less clicking and internal pain than before already and am anxiously awaiting my 6 week post-op visit to learn of my progress. I have been told repeatedly by PT and surgical professionals that I am much ahead of schedule due to being proactive.

    Much of the pain can be caused by what seems like minor swelling/inflammation. Instead of icing only on days when you think you need to, ice twice a day regularly. Take the antiinflammatories advised by your physician and do the research and make a decision to do SOMETHING. Waiting will only cause tears to be worse (as they will continue to catch and tear deeper) and a torn ligament will NEVER repair itself, only cause more damage to cartilage and meniscus. Consult PT about exercises you can do pre-surgery and ask all the questions you want to know. You are paying them to help you. If you don’t like your surgeon, find a new one. There are a lot of great ones out there. Good luck all.

  12. Harold says:

    I am a 60 yr old male. I am in extremely good condition and was playing tennis 3-4 times a week. Heard and felt a tare in my left knee while playing back in December. I had an MRI which showed a torn meniscus
    and possibly some arthritis. The surgeon said they would trim the meniscus and possibly do micro fracturing for the arthritis, I had the surgery in January and there was a defect on the tibia, so the micro fracture was done. I was really never given the info on how difficult that recovery would be. I have had meniscus repair on my right knee several times over the years and from my experience it was no big deal.
    Nothing was discussed about weight bearing so I used crutches for a couple of days and put them away. I felt pretty good for awhile, but the pain has increased, soar and stiff much of the time. Some days very difficult to walk around.
    I have been icing and and started PT following the rehab exercises, some days feels better than others. It’s been six weeks, saw the Dr. and he said if this didn’t calm down he would give me a cortisone shot and maybe start on synvisc.
    I have been reading, should have done this before! But most articles say there should be no weight bearing for six weeks. Some say then you should wear an off loader brace for some period. I am concerned not having done any of this might affect the outcome. Any thoughts?

  13. Graham Cole says:

    I like many posting here am frustrated at having been subjected to the microfracture procedure via the UK NHS.

    I play (used to play that is now) squash regularly, run, cycle and go for the occasional Gym session and swim. I’m 59 yrs old and had a small, or the so the Consultant told me, lateral meniscus tear before going in 36 weeks later (!) for my “exploratory surgery and meniscus trim”. I could expect to walk from the hospital and resume sport in about a fortnight I was told. Sounded promising, but I was slightly hesitant about the surgery as the knee seemed to be improving steadily and I was back cycling and playing squash – albeit poorly and in a brace. So how was I to know that THIS would be done!

    I’m told 4th hand, that the surgeon found a “massive” meniscus tear and grade 4 arthritis on investigation and decided to perform MFR – which has effectively ended my life for 2 months as I’m told by one of the 4 consultants I’ve seen to date (still not seen the person who performed the surgery) that I have to stay on crutches and be non-weight bearing for two months! The last consultant I met didn’t seem to know a thing when I asked him what exercises I could do (after 6 weeks) so explained to him what the Steadman protocol was as I’d read as much on the web. He told me to ask the Physio, who sadly had already asked me to ask the Consultant !! I’m resorting to following some guidelines from the Steadman Protocol, which my Physio also reads to me, and although my Physio recommended Hydro Therapy a fortnight ago, no such service has been forthcoming. To say i’m disappointed and depressed is a mega understatement as I’m not earning any more (Who wants to employ a consultant PM on crutches).

    Hmmmmm……not sure why I’ve posted this.

  14. Shawn says:

    I came out of meniscus surgery and was told that the surgeon had to microfracture my femur (trochlear) after discovering a large cartilage tear. I am now on closing in on 5 weeks of non-weightbearing therapy and I remain cautiously optomistic. I cringed when I read that some of you were advised to load weight on it during your first six weeks. There was no way I could have done that, even if advised to do so.
    I have “pushed” the envelope a bit by riding a stationary bike (every day starting at the 2 week mark) but haven’t had any pain associated with it. PT twice a week includes range of motion excercises and quad-set exercises. I am very concerned about how I’ll respond to putting weight on it in a couple of weeks. I will try aquatic techniques first to ease into it, and I will not put my crutches away until I’m convinced my knee can handle the load of walking.
    I have had that old familiar random stabbing pain in my knee (at the fracture site)when it twists in certain ways. It’s very similar to the pre-surgery pain. I’m still holding out that this pain is from still-exposed nerves and unhealed bone. I’m keeping my fingers crossed that the pain subsides with time.
    I was unaware of the “unloader brace” before I read this article. I will be calling my OS tomorrow to ask about being fitted for one for when I tranistion to weight bearing therapy.

  15. Gail says:

    Had microfracture surgery two weeks ago. Dr says to do exercises but unable to fold knee, cannot put full weighbearing on leg, knee area still swollen. I have a large Bakers cyst behind same knee and a tear in ACL but these were not addressed in surgery. WHY???? The pain is getting a little bit less but not to where I thought (and was told) I would be after two weeks. Leg raises are out of the question, I feel as though my leg is in locked position most of the day just like prior to the op. Its very upsetting. These crutches are exhausting just to get around house etc. Doing ice packs all day and night, taking pain relief tabs reluctantly. Impatiently waiting for this to heal!!!!!!

  16. Brad says:

    So from what I’ve heard- both from my doc and various literature on the web- micro fracture has a poor outlook in older patients with trochlear tears. And if you ask me, I would consider all of these commenters “older patients”. Can any younger folks give me a testimonial about recovery from micro fracture surgery, not someone who’s still trying to play basketball or go jogging in their 40’s and 50’s. I turned 30 a few weeks ago and won’t be getting the surgery til at least summertime and need some words of encouragement if they exist…

  17. Tracy says:

    Brad…I am a 37 year old female. I have endured this surgery once already when I was 34. As much as I hate to say this, I am less than one week post op as we speak from my second go round. The passages I have read here are like me telling my own story. However, I do feel better about this surgery than I did my last one 3 years ago. A great doctor and communication can make all the difference in the world. A piece of advice…go to a doctor that works on college or professional athletes. I drive 3 and a half hours one way to see my doc. and I wouldn’t change a thing as of yet. I wish you the best of luck and hope this helps (and that I’m not too old). Lol.

  18. Sam says:

    Brad…I’m 29 about to be 30 next month. The only update I can give you is that I had my surgery Feb 14 and the Dr who has done a lot of surgeries on athletes was good but he told me a few things I didn’t want to hear. Firstly let me tell you I tore my ACL in 2009 from a bad soccer tackle from there I was an idiot and didn’t get surgery while my knee eventually got better about 6 months no activity (a lot of limping). I started running about 2 miles a day and eventually it got better and went back to playing soccer…UNTIL random one day playing soccer it buckles and back to swelling, limping etc. Now this is 2010 go back to running after say a month or two then soccer and eventually just randomly it will buckles. Which makes sense my ACL is torn I piveting at a fast pace its going to pop out, this would go on for about a year. I would run 5 miles 4 days a week no problem and play soccer but something times even with a brace it would buckle. For a good 2 years I was super active with a torn acl, meniscus, and my cartilage was going. Finally Oct 2011 I kicked my last soccer ball and it just didn’t want to get better, I had a sharp pain in my knee and the swelling went down but I couln’t even jog! Sharp pain when I walked, climbed stairs, just general things.

    So fast forward to now surgery in Feb 14. 2013 (insurance reasons) I was a OS nightmare he told me I had a torn acl and menicus, day of surgery I woke up to him telling me he did a microfracture and to read about it and I may want to pick up a sport like Golf. LOL he’s not a fuzzy warm feeling kinda Dr but he did well. Its about now 7 weeks. I’m still on crutches(have to do 8 weeks). I do my PT but its all really simple stuff for now, like bike no weight and little exercises a 90 year old grandma can do. I was on a CPM machine for two weeks. The trick to keep the leg moving so scar tissue doesn’t form to make it stiff. You also if you have to get an ACL try to straighten it out which I was lucky to do in a week and get a full ROM. The trick is be patient let the blood flow and heal, you may not get the cartilage you had growing up but its something. Do your research and PT and feel your body out. Also try to built that leg up, I was on a stationary bike for a couple of months before surgery, that helps with healing. I know I can walk and trust me I have tried with minimal pain but I rather it just heal. I’ll post an update in another 2 months, I hope I can run again 6 months from now but if not looks like swimming and biking is my future. Good luck

  19. Jeremiah says:

    March 27th I had an femoral micro fracture, ACL replacement, and meniscus trim done at CU sports medicine. The doctor recommended this surgery after a consultation and M.R.I. I researched the operation thoroughly (study results, ideal candidates, Six weeks on crutches, the recovery being very dependent on allowing the blood clot to heal so the cartilage can regrow) before making the commitment to a long boring recovery. I go to my first P.T. tomorrow I’ll comment on my rehab later.
    Choose your doctor’s wisely, they’re not all the same, some know more than others, find a specialist that does the operation frequently and utilizes the latest methods. The field of medicine is advancing rapidly.

    You only get one body. Take care of it. Please.

  20. Philip Olson says:

    Just had meniscus repair today. They did the microfracture… I’m 43 and highly active. I’ll post more as time goes by. Hope to be playing sports by July.

  21. Jeremiah says:

    I didn’t have physical therapy as I had thought. I went to the doctor’s office today. The PA explained the pictures today. Emphasis on the important to acquire Range of Motion then moderate into weightbearing. I asked where my arthritis was and we could see where by looking at the M.R.I. The PA pulled it up on the monitor in less than a minute.
    asked what exercises they would have me do to get back my ROM? She said use gravity to get my leg straight, sit in a chair and inch my foot back. I haven’t had pain since 8 days post operation. Now I’m straightening my knee on the couch. Definitely feeling the burn, even with pain pills and beers. I recommend it.
    Well, I got my short term goal and am gonna be working on it. She teased me that resting my leg of a pillow is comfortable but not effective rehabilitation.

  22. Jeremiah says:

    It’s day 9 post surgery. Working on my ROM. I put the straight leg brace that I let the hospital with on to keep my leg straight for a while. It made me bear through the discomfort and get used to having my leg straight . I did that a few times and it feels so nice. Going the through the movements of walking while crutching, just touching the ground a little bit. Taking an anti-inflammatory and vicodin to make the pain less. It feels so much better when it not swollen.
    I know I’m commenting frequently. When I first read the comments section it seemed negative and uninformed.

    http://www.healio.com/orthopedics/knee/news/print/orthopedics-today/%7B035af345-dade-458b-bc76-513f33028d34%7D/microfracture-success-depends-not-only-on-the-operation-but-rehabilitation-as-well.

    This article recommends 20 to 30 percent weightbearing for eight weeks. The title is ” Microfracture success depends not only on the operation but rehabilitation as well”. Sounds like a lot of self control to not get on it too soon and beat up the blood clot that is making cartilage grow.

  23. sammy says:

    I just had surgery to remove a plate from an osteotomy I had 2 years ago. they decided to do micro fracture surgery as well. I didn’t know and was walking without crutches the next day.When I went to my Dr 4 days later I was told to walk on crutches.Have I done irrepairable damage or if I keep using the crutches now will it still work?

  24. Jordana Bieze Foster says:

    Thanks to all who have commented on this article. Although LER is a magazine for practitioners, not patients, this discussion inspired us to do another article looking more closely at microfracture from the patient’s perspective. That article, published in the April issue of LER, is available here:
    http://lermagazine.com/article/microfracture-surprises-tarnish-the-experience
    Let us know what you think.
    — Jordana Bieze Foster, Editor

  25. Sabrina says:

    I had scope surgery Feb 11, 2013- when I get home I find out my 5th area was microfracture. Orders for crutches for 48 hrs. But still used them both for a week. One for the 2nd week. Started therapy 3rd week. Done good. Sent back to very physical job 7 th week. Day 3 of work my knee was so swollen could not get 90 degrees. Therapist said this was normal. 10 wks post op and 3rd wk of back to work called Doc and he drew 50 cc of fluid off my knee. Went back the next week and put a brave on and out of work agin. Anyone had the fluid issues? And why do some go NWB for weeks and some hardly even use crutches? I am extremely frustrated… Doc wants to do gel shots next week- is this going to help? If it doesn’t he is going to send me to a cartilage specialist. The fluid just keeps coming back.. any sugestions or advice.

  26. Michelle says:

    I had my micro fracture done nearly 4 months ago but I started with knee problems 10 years ago at the age of 32 when my knee locked and I had intense physio which resolved it up until 2 years ago when my knee locked again. I go walking a lot and had just joined a gym, 5wks later after tremendous pain and swelling I finally had an arthroscopy and was told I had 2 large meniscus tears and grade 4 arthritis. 8wks later started physio and eventually got back to normal the best way I could but knew deep down I would never be the same! Then 18 month later I was having problems again and was sent for an MRI scan which showed loose fragments which needed to be flushed out so I went ahead with the surgery in January thinking 2wks and all would be well. But how wrong was I, when I woke the surgeon told me he had done a micro fracture as it was worse than he thought which would mean me being on crutches for 6wks, I was mortified but I felt positive as I had very little pain compared to the first operation. The rehab is so hard when you have a house and family to look after which was frustrating at times. Please don’t panic when you hear the fluid squelching when you start to bend your knee a few days after surgery like I did. After 5wks of being on crutches I saw my consultant and said I could get rid of them and keep up with the physio. How difficult it was, so I weaned onto one for the next 3wks but was still in pain and could feel it catching when walking so I was panicking thinking it hadn’t worked. With plenty of physio, painkillers and icing loads it eventually got a bit easier and I returned back to work after 8wks, it was hard but I was so pleased to beable to drive and get back to work. Now I go to physio classes which have helped so much and finally feel it may have worked after all, although it still swells and feels stiff I only take the painkillers when needed and make sure I ice it. My next appt with the consultant is this month which he may give me an injection but I was told last time that I wouldn’t feel the benefit for up to 4-6 months and takes 12 months to heal. So for all you guys I am now feeling positive and have hope but I know I will never be the same and wonder what my future holds but you certainly appreciate things a lot more when you’ve been through the longest and hardest rehab ever. I certainly couldn’t go through it again in a hurry that’s for sure!!!

  27. Candace Scott says:

    I had my 4th knee operation on Tuesday May 2013 in Syracuse, NY. I had arthro for a torn meniscus, and while in there, my doc found floating cartliage requring microfracture. Im 36 and very active–and my recovery is going wonderful! I’ve had 2 PT appts, got on the bike today, am at -2 degrees for straightening and 100 degrees for bending. My success is due to my incredbile surgeon, Dr. Todd Battaglia.My group, SOSBones is phenom.He told me the weight bearing issue w microcfracture is all dependant on where it is. Mine is directly in the middle, in the “grove” for the knee cap.Im ok to bear weight as tolerated.And Im tolerating a bit!! Im barely taking pain meds, just for my PT appts.I stick to the exercises he gave me to do—-example 500 “knee bends” a day, bc that’s what promotes your cartilige growth and will help you heal quickly.

    My previous 3 operations were for a torn ACL when I was 17—1 artro and 2 reconstructive. I will say, that I firmly believe that the success of your knee operation is completely dependant upon the skill of the surgeon. My 1st arthro and 1st reconstructive were awful—the dr misplaced the graft by a quarter of an inch! I was in the hospital 5 days and unable to walk!

    I got referred to SOSBones—and hour drive for us—but completly worth it! The 2nd reconstructive in my still damaged ACL was done as outpatient—and I was bearing weight within 2 weeks!!!! I will never go to another group!

    Do your research on your drs— Microfracture is working for me!

  28. Dean Goodway says:

    I had micro fracture two weeks ago, it was mentioned before I went into theatre, but I didn’t fully understand the consequences, as I to was told I would walk in and walk out and be back to sport in two weeks! I didn’t see my surgeon after the operation and apart from crutches, I have been given no post op advice apart from six weeks on crutches!
    I’m worried to death I will not be able to return to basketball and cricket my two sports, and I’m looking for a physio who knows what he/she is doing re post micro fracture re-hab!

  29. Jeremiah says:

    I’m nine weeks post op and doing fine. I was on crutches six weeks toe touch weight bearing. That was the hardest part. Three weeks off crutches and so far so good. Can get my knee straight. The P.T. and doc said to not concern myself with the other direction, even though I can get my heel three inches from my butt. The article Jordana Foster linked to was pretty good. Especially the stuff Dr. Steadman said. Brought a trainer for my bike. My pt says my mantra should be “slow and steady”. Fine with me. I can tell when I overexercise because it aches. We work on core exercises and balance stuff because she says the surgery cut neuroreceptors. Makes sense. They say don’t carry weight, like my daughter, because the lesion is still, and will be healing for a year. I feel bad for the people who got surprise microfractures and have had failures. I’m in no hurry to get 100%. I can get strong and regain muscles, but I can’t make the cartilage heal faster. I am taking Flex-a-min, glucosamine, can only help.
    Will post later. Had an ACL replacement also, so I have four more months of recovery anyway. I’ve been down this road before and have partially torn after two months after my first ACL replacement.
    Slow and steady. Good luck out there.

  30. gasjob says:

    I’m 49 (ouch). 4 months post ACL, medial and lateral meniscal repair and debridement and 1+cm microfracture. Skiing injury. I’m a running junkie. Surgeon found significant old cartilage damage (surprising and asymptomatic) along with the profound acute injuries.

    I’ve rehabbed from ACL on the other knee and both shoulders with major surgery. BUT. My initial recovery and rehab were slow from this comparatively(remember, I’m old) ! A lot of swelling and pain and disability. I’m now biking 60-100 miles/week. Walking only. Stair climber machine, elliptical and numerous exercises for strength and stability. Occasionally some pool running but I hate the pool for exercise. Running is out for another 6 months. Not a single quick step. Not even to beat traffic across the street. I’m still taking anti-inflamatories (Mobic, meloxicam). My surgeon suggests never running. I expect to return to form.

  31. Sally says:

    I am 17 years old and had microfracture surgery on my left patella in march of 2013 after a volleyball injury. I used crutches for 3 weeks and at 2 months I was able to begin easing my way into volleyball practice. At 3 months I was back in the full swing of volleyball with only some aches after I would play. Now at almost 5 months I am playing in college. I have to limit myself in conditioning a lot and I am not up to the level of play I was at before. I still have aches and cracking after a workout, but it is tolerable.

  32. Ed says:

    After reading all these comments/stories, I’m at a loss with regard to what I should be doing! As with many I went into arthroscopic knee surgery about about 12 days ago thinking that I would be having only a partial meniscectomy (medial, left knee). After the surgery I was informed I had indeed had the partial menisectomy, but also chondroplasty and microfracture for a focal articular cartilage injury. Had a post-surgery follow-up visit with the OS 6 days following surgery. Had moderate amount of effusion, but had had no pain – never had to take any of the pain med I was given b/c truly never had any post-surgery pain. Stitches were removed and I was told I could walk without crutches on level surface… no stair climbing, be very careful… nothing beyond walking at a slow pace, no pivoting with weight on knee, etc. But… then I see on here where the rehab should require weeks on crutches with NO weight bearing! Which is it?

  33. Fiona says:

    I loved this article!
    Thank you!
    I was just checking up a few things, as I am an Accredited Exercise physiologist in Australia, and have a lady im assisting post arthroscopic cartilage repair in her knee.
    I actually learned a few things from reading your article – thak you so much for sharing your passion and knowledge!

    Fiona :)

  34. Christine says:

    I am one month post op from an ACL reconstruction with hamstring graft, mensicus repair, and microfracture procedure on articular cartilage. I was on crutches for 4 weeks with no weight bearing at all. I tore my ACL playing soccer in October 2011, had an MRI and had a pure ACL tear with no damage to mensicus or other surrounding areas. While waiting 2 years for surgery in Canada, I managed to tear my meniscus and articular cartilage while on vacation, leaving my knee locked in a bent position for four weeks.

    After one month and being able to fully weight bear, I still cannot straighten my leg fully or bend my knee past 90 degrees. My PT tells me rehab is taking so long due to the fact that my leg was locked and my muscles were tightened/atrophied during that time. It sucks because before I had the locked knee, I was doing crossfit (while wearing a knee brace) and my knee seemed to be strong. I had done a lot of rehab immediately after tearing my ACL in 2011.

    My knee is still swollen, and I am only icing after PT that I do 2x a day. I’m worried about how long it is taking for my leg to straighten out. I am trying hanging it off the end of the bed, putting a dumbbell weight on it, and doing a lot of quad contractions, but nothing seems to help.

    Right now I walk around with one crutch as my knee is still partially bent. It’ll be long while til I get back to soccer, crossfit and snowboarding.

  35. Steve says:

    Well, add another horror story to the list. I went in for surgery very reluctantly 5 weeks ago for meniscal tears. I specifically expressed to my OS that I wanted conservative treatment due to my high level of activity. Unfortunately, the communication level between us has been poor at best. I had a gut feeling that it was going to be worse than just a repair, but nothing was discussed about a possibility of a microfracture procedure. As so many ahead of me reported, I woke up with the news that I had lost a lot of cartilage in my trochlear groove and they had to microfracture the area. This was given to us in a passive way with no pertinence. I was instructed to use crutches for ONE DAY!

    Since I am a “by the book” guy, that’s exactly what I did. I was also instructed to begin PT the following week. My knee was extremely swollen but I struggled to get through the exercises. The ONLY way I have been able to walk or do PT was because of continuous icing 24/7 with a brace I had purchased. I was doing straight leg exercises and even balance work!!! My knee was not in terrible pain but really throbbed and was very hot at the end of the day. At the 2 week Post Op the surgeon very briefly muttered something about a possible need for a cartilage replacement and his PA drained 75 cc’s of blood filled fluid out of my knee! He explained some things better than the OS did, but I still did not know anything about a microfracture procedure or how serious it was.

    Now, due to the PT approach and OS instructions (or lack of) I have been trying to live a normal life. Working as a dentist, I am on and off my feet a lot. Also even doing yard work with heavy equipment! At 4.5 weeks I didn’t have my ice brace one day and noticed intense heat/throbbing in my knee. Also a sandy/gritty/gnawing” feeling. Knowing that this couldn’t be normal this far down the road I decided to check out what a microfracture procedure really was. I found this site and forum and almost wanted to cry. Words cannot express the loathing I have for the mis information I have been given. 6 weeks non weight bearing???!!!! Are you kidding me?!! I called the OS assist. to ask her about this and she re- assured me it’s absolutely fine that I was on crutches only one day. It is now 5 weeks and I’m pretty sure the damage is done for any chance of proper healing.

    I spoke to my PT to express my disgust and he concurred that he felt the OS was pushing it with his orders, but still felt I should weight bear to keep my quads firing. I see my OS next week for my 6 week post op and he will hear an earful. I am thoroughly disgusted at the lack of communication and understanding on my part about the procedure. I do blame myself as others have, for not educating myself sooner. I feel pretty lost and not sure what to do, but if more surgery is required, that OS won’t touch me with a 10 foot pole! I wish everyone here or who is searching out this info the very best and my hope is they don’t end up in a situation like I have. I hope that I can return to normal life at some point. But for now, it is very questionable. I will also seek a second opinion from another OS very soon.

  36. Johnathan says:

    I had microfracture surgery on my right knee Nov 5, 2012. I’m really surprised to see so many people that were weight bearing so soon after surgery. I was on crutches, NO weight bearing for 6 weeks. Of course this left my right leg extremely weak, but I do think it gave my knee a pretty good opportunity to heal. Prior to the surgery, I played basketball regularly, ran, crossfit, lifted regularly. At 6’4 1/2″ about 250lbs, about 18% bodyfat (pre surgery), I was afraid of weight gain that would be extra pressure on both knees. Almost a year after the surgery, I’m just recently back to light jogging. Havent even thought about crossfit as of yet, and havent played basketball. The leg is getting stronger, not at 100% yet and I’m up to about 265 and about 20.5% bodyfat. For me its a cycle, I cant do much running or many of the things that helped me keep weight off, to lessen the load on my knees because of the occasional pain, but taking off the weight will help relieve the pain, etc, etc… Some days/weeks are better than others. Its just a really slow process. Right now I am trying to do sprints and basketball drills 2-3 times/week on the court just to get my wind back, and get used to “basketball moving” again. My suggeston is to let pain be your guide. Microfractures are extremely traumatic, so there’s going to be pain. We have to learn what the pain means. Have to be able to differentiate between pain from the procedure and recovery, and pain from over exerting while training/rehab. Everybody hang in there though! Set small goals and gradually I’m sure we’ll all be close to where we want to be!!

  37. Karen says:

    I informed myself very well before surgery and took 4 months to decide against microfracture surgery due to several factors … I told the doc I felt I was not a candidate for MF due to the intense therapy protocol and that I was not willing to give up that amount of time out of my life (reading is was a 6 month therapy period), and also needed to be able to take care of my 80 year old mom. So I signed a consent form in his office for only chondroplasty with the understanding I could do MF later if this did not work. However, Oct 30 2013, that all changed when he decided in the operating room to do the MF surgery anyway. It’s been tough to say the least and at 5-1/2 weeks was permitted to ditch the crutches. Unfortunately, that’s not happening… the knee is too weak, the pain is too intense. I feel my surgeon overstepped his boundaries big time since I had a very pointed conversation with him about not having MF. And he is a top surgeon, most trusted, etc in his field. Has has stolen a portion of my life I’ll never get back … and taking care of my mom is definitely out of the question for a while.
    Just praying for the best outcome now since what’s done is done.

  38. Karen says:

    I informed myself very well before surgery and took 4 months to decide against microfracture surgery due to several factors … I told the doc I felt I was not a candidate for MF due to the intense therapy protocol and that I was not willing to give up that amount of time out of my life (reading is was a 6 month therapy period), and also needed to be able to take care of my 80 year old mom. So I signed a consent form in his office for only chondroplasty with the understanding I could do MF later if this did not work. However, Oct 30 2013, that all changed when he decided in the operating room to do the MF surgery anyway. It’s been tough to say the least and at 5-1/2 weeks was permitted to ditch the crutches. Unfortunately, that’s not happening… the knee is too weak, the pain is too intense. I feel my surgeon overstepped his boundaries big time since I had a very pointed conversation with him about not having MF. And he is a top surgeon, most trusted, etc in his field. He has stolen a portion of my life I’ll never get back … and taking care of my mom is definitely out of the question for a while.
    Just praying for the best outcome now since what’s done is done.

  39. TONY ELLIS says:

    Hi all im a 52 year old man living in New Zealand.
    All i can say is thank god ive found this site two days after my surgery for what i was told was a small miniscal tare repair and would be back to full fitness in two months…
    whilst i was in post op in the recovery room and half asleep my surgeon mentioned something about a thing called microfracture he had performed on me during the op. gave me some photos of the surgery and told me the nurse would explain everything to me..
    she took five minutes to tell me i should use crutches for a bout two weeks but would be ok to partially weightbare…with that i was out the door and on my way home..
    Im a cop in New zealand so obviously ” fit for purpose” is an essential part of my job..
    Luckily the next day a representative from the polce rehabilitation office came to see me and OPENED MY EYES as to what had been done to me..
    I have now been told not to weight bare for 4-6 weeks and will be on light duities for upto 4 months with ongoing assessments..
    I find it unbeleivable that my surgeon who i saw several times before the op never even menitioned a thing called microfracture and then spent five minutes post op explaing it to me .
    Most of the posts and other sites i have read seem to be of a negative nature..my fingers are firmly crossed that ill repair quickly and be back at work soon…
    ill repost as time goes on..good luck to all concerned

  40. Karen says:

    9 weeks after microfracture surgery and I have done all of the therapy protocol to date. Anyone experience loose feeling knee afterewards … actually both of my knees feel weird. Maybe it’s from being on crutches for so long and hopefully they’ll start feeling more normal soon. I just didn’t expect this feeling. It’s not as much pain as it is just loose or numb like feeling. Hope to hear from someone. THanks

  41. Karen says:

    Steve, I just wanted to comment and say my OS said I could bear weight immediately but only because of the size of my cartilage lesions. They were small and well defined. Not sure if this fits your case but even though he said this, I didn’t bear weight because my phys therapist recommended not to. It also matters whether your surgery was on a weight bearing area or not. If not, weight bearing is ok according to research. So hopefully no damage has been done.
    Hope you’re doing well. It sounds like you’ve done a lot more physical activity than I’ve been able to do so far. I am a 55 yr old female, not overweight, but not in the best physical shape before surgery.

  42. Ralph Salerno says:

    The good the bad and the ugly. My surgeon, a good friend, fully understood my activity level and after an MRI and some treatment decided to do a scope for simple cartilage clean up. At pre-op on 10/3/13 no problem you’ll be on a bike tomorrow and skiing by Christmas. In post op 4 hours later, sorry you will be on crutches for 6 weeks and won’t ski till 2015. The following moments were filled with photos, explanation and an education to something I never heard of before, micro fracture surgery. Needless to say I was crushed, and the following weeks yielded a bad attitude and tons of apprehension. Three months later attitude is positively adjusted, apprehension still exists but has diminished and I am finding that MF rehab is as much an art than it is a science. The brace & crutches are gone, the cane is in the trunk of the car and the limp and ability to climb stairs ebbs and flows not only day by day but also from morning to night. When in doubt, ice, take ibuprofen and be passive; as being passive with your activity can’t do damage that inhibits scar tissue formation. I am blessed with a surgeon/friend who I trust and who has been in touch with full disclosure regarding with what my expectations should be and their timetable. I am a type A, and when not in the gym, I was running, spinning, biking, hiking, tele skiing, alpine skiing, snow shoeing or walking a golf course. I have accepted my down shift as I approach 50 years of age; however, I realize when the time comes to fully re-engage it will be done slowly and it will be littered with obstacles and pitfalls. In the meantime I have adjusted my diet as my ability to out work a bad diet no longer exists. The ugly reality is be it trauma or age none of us will ever be 100% again.

  43. Dennis says:

    i am amazed to read so many micro fracture related blogs…
    the one ingredient most people lack is patience!
    this is serious surgery, and you should treat yourself as such.
    those first six weeks of non weight bearing is imperative to the recovery cycle, after that moderation is the key to recovery.
    i am 6 months out of micro fracture and the results are what my doc and i expected…
    no pain, biking, jogging, yoga, and the activities that keep the body strong, but stress off the knee.
    i’m a trekker/ climber, and i will be climbing Mt Elbrus in Russia 18,000 ft in July, one year after my surgery.
    i wish all micro fracture patients the best/ god bless

  44. David Ko says:

    Hi everyone,
    I am over ONE YEAR out from my MF (2/2013). I haven’t been able to walk DOWN stairs normally since 6/2013…. Due to family tragedy and work, I have been unable to properly rehab and build my muscles, namely Quads. No doctor knows exactly what is wrong with my knee, but according to MRI and X-ray, my knee looks pretty good. There “might be” something right below my knee cap where the MF was performed which is inhibiting my initial motion from a straightened leg. This is why I can’t walk down stairs (your leg straightens fully as you begin stepping down). In June I could not even walk down gingerly a 5cm high stair. Now I can walk SLOWLY down a 20cm high stair, but after a few times, it “locks” up again.
    My guess is that if it wasn’t a muscle issue, and that it was more structural, then I wouldn’t be able to even do even ONE stair. I can turn and bend my leg on a patient table just fine, but when there is anyweight bearing (stairs) then that is when my leg feels like it is stuck when I try to bend.

    HAS ANYONE EXPERIENCED A SIMILAR FEELING/PROBLEM?

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