Ankle Arthroscopy with Microfracture

Precautions

• Splint after surgery to limit ankle motion
• Non weight bearing (NWB) on two crutches so the microfracture site is protected while it heals

Phase I · 1–5 days after surgery

Wound care

• Check the incisions for signs of infection
• Start scar management once the incision has closed

Modalities

• Ice and interferential current (IFC) prn for pain and swelling

Gait

• NWB

Boot / brace

• Worn up to 4 weeks

Phase II · 5 days – 4 weeks after surgery

Wound care

• Check the incisions for signs of infection
• Start scar management once the incision has closed

Modalities

• Ice and IFC prn for pain and swelling
• Contrast bath if swelling is significant

Range of motion

• Gentle open-chain AROM begins at 4 weeks

Strengthening

• Isometrics begin

Gait

• NWB until 6 weeks

Phase III · 4–10 weeks after surgery

Wound care

• Continue scar management

Modalities

• Ice, IFC and contrast bath prn for pain and swelling

Range of motion

• Continue AROM and PROM; progress to more aggressive ROM at 6 weeks

Strengthening

• Continue isometrics; active strengthening from 6 weeks; Theraband from 8 weeks
• Closed-chain strengthening as weight bearing allows

Gait

• WBAT from 6 weeks, then FWB from 8 weeks

Balance / proprioception

• Start at 6 weeks post-op once FWB
• Two-leg balance work, progressing to single leg
• BAPS: seated first, then standing
• Balance board

Boot / brace

• Wean from the boot at 6 weeks post-op; D/C by 8 weeks unless the surgeon directs otherwise

Phase IV · 10+ weeks after surgery

Wound care

• Continue scar management

Modalities

• Continue prn

Range of motion

• Continue as in Phase III

Strengthening

• Continue as in Phase III

Balance / proprioception

• Progress to single-leg work if not already done
• Jogging, agility drills, plyometrics and sport-specific activities from 12–14 weeks, subject to the surgeon's restrictions
• Multiplanar balance work; Fitter
• Running and cutting drills for sport
• Functional testing: less than 25% deficit for non-athletes, less than 20% for athletes

References

Adapted from:

• Brotzman SB, Wilk KE. Clinical Orthopedic Rehabilitation. 2nd Ed. Philadelphia: Mosby; 2003
• Ferkel RD, Whipple TL (Ed). Arthroscopic Surgery: The Foot and Ankle. Philadelphia: Lippincott – Raven; 1996
• Maxey L, Magnusson J. Rehabilitation for the Postsurgical Orthopedic Patient. St. Louis: Mosby; 2001

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from Geoffrey S. Van Thiel, MD, Rush University Medical Center (hosted by William Beaumont Army Medical Center), "Ankle Arthroscopy with Microfracture", Undated, published by William Beaumont Army Medical Center (reproduced with attribution; the clinical parameters are theirs, the wording is ours). Original: Ankle Arthroscopy with Microfracture.pdf.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols