Question:Our 23-year old son is on a semi-professional baseball team. He says he tore his knee cartilage clear down to the bone and needs surgery. They are going to drill tiny holes in and around the damaged area. What kind of rehab will he need to get back in the game?
Answer:The treatment technique you are describing is called microfracture. This approach helps bring about a healing response in an area that doesn't normally heal well on its own.
The surgeon carefully drills tiny holes around the edge of the defect. Then holes are drilled directly inside the defect. This second group of holes is spaced far enough apart to allow for the area to fill in and heal.
The rehab program is as important as the surgery. The patient must follow the steps of recovery very carefully. Too much weight too soon on the joint can stop the healing process.
Movement is important after surgery. The patient's knee is usually placed in a device called a continuous passive motion (CPM) machine. The machine is set to allow a certain amount of knee motion. The specific settings depend on the location of the lesion. Sometimes bracing is also used. Again, this depends on where the lesion is located.
After the first eight-week phase of healing is over, then patients are weaned off crutches. They can start to put full weight on the joint. Exercises are prescribed to regain full joint motion. At this point, resistance exercises are added.
A physical therapist usually helps athletes move through each phase of the recovery and rehab program. Phase three builds on the results of the first two phases. Endurance is the focus of the next phase. Patients must be careful not to overload the joint.
Agility drills, running, and speed drills are gradually added into the program. Returning to the game may be delayed for six to nine months in cases where pivoting, cutting, and jumping are required.Yi-Meng Yen, et al. Treatment of Osteoarthritis of the Knee with Microfracture and Rehabilitation. In Medicine & Science in Psorts & Exercise. February 2008. Vol. 40. No. 2. Pp. 200-205.
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