Fig. 14.1
Phase I: extension and flexion exercises against resistance
14.6.2 Phase II: 3–4 Weeks
After these 2 weeks, partial (eggshell) weight-bearing on crutches is allowed, as tolerated. Progression to full weight-bearing is prescribed over a period of 4 weeks. The range of motion exercises against resistance are extended to three to four times a day.
14.6.3 Phase III: 5–6 weeks
During weeks 5 and 6, the patient practises full range of motion against gravity by exercising on a step with both feet simultaneously (Fig. 14.2). After week 6, this exercise can be performed on one leg (Fig. 14.3). The programme can be optionally guided by a physiotherapist.
Fig. 14.2
Phase III: full range of motion exercises against gravity on a step on both feet
Fig. 14.3
Phase III: full range of motion exercise against gravity on a step on 1 ft
14.6.4 Phase IV: 7–16 Weeks
Sagittal lunges and exercises can be practised after week 6. Thereafter, patients are allowed to cycle on the home trainer, start walking on the tread mill or use the cross trainer and rowing machine. Balancing and eversion/inversion exercises can be started in this phase. The resumption of sports is detailed in the next chapter ‘Return to Sports’. To summarise, a gradual increase to impact activities can be considered after 3–4 months, whilst return to noncontact sports is mostly achieved after 4–6 months.
Additional modalities, such as CPM, cryotherapy or pulsed electromagnetic fields, could possibly be advantageous for an accelerated and improved outcome, but their exact value has to be further investigated. Any protocol may need to be modified and individualised for each patient taking into consideration patient and lesion factors. High-quality future studies will provide further evidence for creating an optimum rehabilitation protocol after microfracture which will be advantageous to patients and the outcome of surgery.
14.7 Conclusion
A single, ideal rehabilitation programme after bone marrow stimulation for talar osteochondral defects still does not exist. It appears that whilst high shear stresses may lead to failure of the repair at the early postoperative stages, there is evidence that moderate dynamic compression and low shear stresses may be advantageous to the repair tissue and that immobilisation and static compression may have negative effects. Rehabilitation with gradual return to weight-bearing after 4 weeks is suggested. Further high-quality studies are necessary to provide clinical outcome data to support any rehabilitation regimen.
Conflict of Interest
The author has no current conflict of interests with the products presented
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Surgical Approach to Lateral OLT
Rehabilitation After Replacement Procedures (i.e., OATS, Allograft)
Diagnosis of Chondral Injury After Supination Trauma
Arthroscopy After Ankle Fracture
Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT)
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