OSCELL MICROFRACTURE OR DRILLING OPERATION (PATELLOFEMORAL SITES) PATIENT ADVICE.

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1 OSCELL MICROFRACTURE OR DRILLING OPERATION ( SITES) PATIENT ADVICE. Anatomy of the Right Knee example of a trochlea articular defect site Knee Straight Knee Bent KEY: Patella Kneecap Trochlea Groove on the thigh bone lying under the kneecap. Femur Thigh bone Articular Cartilage Protective coating at the end of a bone Articular Defect Area of loss of articular cartilage ACL Anterior Cruciate Ligament Meniscus Crescent shaped washer, commonly referred to as cartilage. Collateral Ligaments Tough bands of tissue, either side of knee that prevent extremes of movement. Fibula Bone at the outside of shin. Tibia Shinbone Articular cartilage is the coating covering the end of a bone. It allows the joint friction-free movement and protects the underlying bone. When articular cartilage is damaged as a 1

2 result of trauma or abnormal wear you may experience pain, swelling and loss of normal function. Mechanical symptoms such as locking, clicking and giving way may also be experienced. This area of damage is often referred to as a defect or lesion. If a defect is present it can often act as sandpaper and go on to wear adjacent joint cartilage. In an attempt to alleviate the problems caused by articular cartilage defects an operative procedure called microfracture or drilling may be performed. This procedure is usually performed arthrocopically (keyhole surgery) and in most instances it can be performed as a day case and will not involve an overnight stay. The athroscope allows the surgeon to view inside the knee joint and assess the articular cartilage defect. The procedure then involves trimming back the defect to provide a stable boarder. The exposed bone of the defect is punctured by either drilling or microfracturing, in order to cause bleeding. The bleeding will then form a clot in the defect, which over time will toughen up and form a scar tissue called fibrocartilage, which is much better for the joint than the exposed bone. In order to protect the immature scar tissue you will be required to limit the range of movement (bending) of your knee for up to six weeks. Cartilage repair using this procedure allows you to return to most activities within three months, though this can vary from person to person and complete maturation can take up to twelve to eighteen months. Included in this booklet is a series of exercises specifically for your affected leg. Under the supervision of your physiotherapist you may be able to perform these exercises independently following your discharge home. Your physiotherapist will add other exercises to these to ensure you are conditioning your whole body and he/ she may delete exercises as you progress. Depending on your physiotherapists clinical judgement you may also be offered other physiotherapeutic modalities in order to promote your recovery. You will be under the care of a physiotherapist throughout your rehabilitation. If you cannot attend physiotherapy at RJAH an appointment will be arranged for you elsewhere. If you have any queries involving your rehabilitation then do not hesitate to contact the Physiotherapy Department at RJAH; *andrea.bailey@rjah.nhs.uk(tel: Fax:

3 EXERCISES FOLLOWING YOUR MICROFRACTURE OR DRILLING OPERATION. THE OSCELL PROGRAMME Exercise within your own limits if you are uncertain of any of the following exercises STOP and consult your physiotherapist. FROM DAY 1 (as comfort allows): (USE ELBOW CRUTCHES FOR COMFORT. LIMIT ACTIVELY BENDING YOUR AFFECTED KNEE FROM 0-30 ) 1. Sitting as below with the thigh muscles of your affected leg relaxed. Move your kneecap side to side and up and down. each direction. 2. Sitting as below, pull foot toward you from the ankle. Tighten the thigh muscles, bracing your knee back straight. 3. As above and lift your straight leg, approximately 6, lower slowly. HOLD sec 4. Sitting as below, ensuring the non-affected leg is bent, lean forwards from your hips, reaching toward your toes. Feel the stretch at the back of your thigh/knee. 3

4 5. As weight bearing allows, lift and lower heels. 6. Standing, place your affected leg behind you, keeping your heel in contact with the floor lean forwards. Feel the stretch at the back of your calf/ knee.. 7. Sitting on a chair, hook your non-affected leg under your affected leg, allowing it to take ALL the weight. Bend and straighten to comfortable limits (in this exercise you may bend your knee beyond 30 ), ensuring you do not use the muscles in your affected leg. FROM DAY 3-5 (as comfort allows): (WEAN OFF ELBOW CRUTCHES) 1. Within the limits of your range of movement (0-30 ) and comfort bend and straighten the affected leg. 4

5 2. As above pausing at various points in available 0-30 range. 3. Lying on your front bend and straighten your affected leg. 4. If available use a Unicam bike on passive movement setting for treated knee. Range adjusted by your physiotherapist as necessary. 5. Standing as below transfer your weight forwards onto your affected leg. Note heel toe movement. Progress the amount of body weight as comfort allows. 6. Standing as above push your weight forwards off your back affected leg. Note toe off movement. Progress the amount of body weight as comfort allows. 7. Standing as below transfer your body weight side to side. Progress the amount of body weight as comfort allows. 5

6 9. As able, balance on affected leg, progress to eyes closed, uneven surfaces etc. (your physiotherapist will guide you) FROM WEEK 4 (as comfort allows): 1. Standing, bend and straighten 0-45 aiming to get the centre of your kneecap travelling over your second toe. 2. If straight leg raising exercise can be achieved with no bend at the knee, add an ankle weight. Lift straight leg approximately 6, lower slowly. 3. Exercises in the swimming pool (hydrotherapy) as guided by your physiotherapist. FROM WEEK 6 (as comfort allows): 1. Cycling on a static exercise bike or Unicam, low resistance. 6

7 2. Sitting on chair bend and straighten 0-30 and the affected leg with an ankle weight. Assist with your other leg between until your physiotherapist advises otherwise. 3. Lying on front, bend and straighten the affected leg with an ankle weight. 4. Bend the knee and ease the heel further toward the buttock assisting with other leg and then using the hand on the same side, as shown below. Feel the stretch at the front of the thigh. 5. Step-up leading with your affected leg onto a low step, progress by increasing the height of the step. 7

8 6. Vary the speed (but maintain control) of any of the aforementioned exercises. FROM WEEK 8 (as comfort allows): NO LIMIT TO RANGE OF MOVEMENT when performing any exercise. 1. Unlimited gym work, including cycling, stepper, rower, etc, tailored to your specific needs. 2. Commence light jogging (on sprung surface). 3. Breaststroke legs/ unlimited swimming. FROM WEEK 12 (as comfort allows): 1. Running as guided. 2. Agility/ cutting/ twisting/ turning 3. Non-contact sport specific training. Start with low efforts FROM (as comfort allows): 1. Earliest return to contact sport, as able. 8