Microfracture (Knee Cartilage) — Complete Exercise Program

Quad Sets

Re-activates the thigh muscle and supports knee control.

What it helps: Wakes up the quadriceps — the big thigh muscles that support and control your knee. Getting them firing is the foundation of a strong, steady leg.

1. Sit or lie with your leg straight.
2. Tighten the muscle on top of your thigh, pressing the back of your knee down.
3. Hold briefly, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Heel Prop Quad Set

Helps the knee straighten fully — your main extension exercise.

What it helps: Helps the knee settle out fully straight. Full extension is what lets you walk smoothly and stand without strain.

1. Place your heel on a stool, pillow, or rolled towel.
2. Allow the knee to hang freely.
3. Tighten your thigh muscles and push the back of the knee downward.
4. Hold for 5-10 seconds.

Tips:

• Ice or a light weight may be added if instructed.

Commonly done as 10 repetitions, several times a day.

Patellar Mobilization

Keeps the kneecap gliding freely so it does not tether and limit movement.

What it helps: Stops the kneecap becoming tethered by scar tissue after surgery. A kneecap that does not glide blocks both full straightening and full bending, so this quietly protects the range of motion you are working for.

1. Sit with your leg out straight and the thigh muscles completely relaxed.
2. Place your thumb and fingers on the edges of your kneecap.
3. Glide it gently toward the inside of the knee, hold briefly, then toward the outside.
4. Then glide it gently upward toward the thigh, and downward toward the shin.
5. Move slowly and only as far as it goes easily.

Tips:

• The thigh must be relaxed. A tightened quadriceps locks the kneecap and nothing will move.
• This should feel like a gentle stretch, not a struggle — the movement available is small.
• Easiest done straight after a shower when the tissues are warm.

Commonly done as 2 sets of 10 in each direction, daily.

Heel Slides

Encourages early, gentle knee motion.

What it helps: Coaxes gentle bending back into the knee — restoring the motion you need for stairs, sitting, and getting in and out of a car.

1. Lie on your back with your legs straight.
2. Slowly slide your heel toward you, bending the knee.
3. Slide it back down.

Tips:

• Only go as far as is comfortable.

Commonly done as 2-3 sets of 10, a few times a day.

Straight Leg Raises

Strengthens the thigh while protecting the joint.

What it helps: Builds quad and hip strength while the knee stays straight, so the muscle works hard without stressing the joint.

1. Lie down with one leg bent and the other straight.
2. Tighten your thigh and lift the straight leg a few inches.
3. Lower slowly.

Tips:

• Keep the knee straight as you lift.

Commonly done as 2-3 sets of 10, once or twice a day.

Ankle Pumps

Improves circulation and helps reduce swelling.

What it helps: Keeps blood moving to reduce swelling and the risk of clots while you're less active — small, frequent, and important early on.

1. Flex your foot up, pointing your toes toward the ceiling.
2. Point your toes down, away from your body.

Tips:

• Move slowly and with control.

Commonly done as 20 repetitions, several times a day.

Glute Squeezes

Gently re-engages the buttock muscles.

What it helps: Wakes up the glutes — the big muscles that steady and support your hip. Getting them firing again is the first step toward a hip that feels stronger and carries you with less strain on the joint.

1. Lie or sit comfortably.
2. Squeeze your buttock muscles together.
3. Hold a few seconds, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Isometric Hip Abduction

A steady, held push outward that loads the side-hip muscles without any movement — often the gentlest way to start.

What it helps: Holding a steady contraction loads the side-hip tendons gently — it often eases pain while it begins rebuilding their strength. A calm, controlled first step before adding moving loads.

1. Sit tall (or lie on your back) with a looped band around the outside of your knees — or simply use your hands on the outside of your knees for resistance.
2. Press your knees gently outward against the band or your hands.
3. Hold a firm but comfortable push — steady, no movement — then slowly relax.
4. Rest a moment and repeat.

Tips:

• You should feel the muscles on the side of the hip working — not your hip pain. Ease the effort if it provokes the sore spot.
• Keep breathing normally through the hold; don't hold your breath.
• Hold, don't bounce — the whole point is a steady contraction.

Commonly done as 4–5 holds sets of Hold 30–45 seconds, daily.

Walking with Crutches or Walker (Non-Weight-Bearing)

Safe, non-weight-bearing walking using crutches or a walker to protect the healing bone.

What it helps: Safe walking with crutches or a walker that keeps weight off the healing leg, protecting the bone while you stay mobile.

1. Keep all weight off the surgical foot, using your crutches or walker.
2. Take short, level trips as needed.
3. Keep the foot elevated when resting.

Tips:

• Follow your surgeon's weight-bearing instructions exactly in the early weeks.

Commonly done as needed.

Heel Slides

Encourages early, gentle knee motion.

What it helps: Coaxes gentle bending back into the knee — restoring the motion you need for stairs, sitting, and getting in and out of a car.

1. Lie on your back with your legs straight.
2. Slowly slide your heel toward you, bending the knee.
3. Slide it back down.

Tips:

• Only go as far as is comfortable.

Commonly done as 2-3 sets of 10, a few times a day.

Seated Assisted Knee Bend

Gently improves how far the knee can bend — often the most important early flexion exercise.

What it helps: Gently improves how far the knee bends — early flexion that makes stairs, chairs, and cars far easier.

1. Sit in a chair with both feet on the floor.
2. Place your non-operative leg in front of the operative leg.
3. Use the non-operative leg to gently help bend the operative knee further.
4. Hold briefly, then relax.

Tips:

• Go only as far as is comfortable.

Commonly done as 5-10 repetitions, every 1-2 hours while awake.

Prone Hangs

Lets gravity straighten the knee fully — the most important early goal after knee ligament surgery.

What it helps: Restores full straightening of the knee. Regaining this early matters more than regaining bend: a knee that does not fully straighten changes how you walk and is much harder to correct later.

1. Lie face down on a bed or couch with your thigh supported and the knee and lower leg hanging off the edge.
2. Let the leg hang freely and relax the thigh completely. Gravity does the work.
3. Allow the knee to settle toward straight. A pulling sensation behind the knee is expected.
4. Hold the position while staying relaxed, then bend the knee gently a few times before getting up.

Tips:

• Relaxing is the exercise. Holding the muscles tight stops the knee from settling and wastes the stretch.
• A small ankle weight can be added once this feels comfortable, if your therapist suggests it.
• This is meant to be a slow, low-effort stretch held for time — not something to push or bounce into.

Commonly done as 2–3 sets of hold 5–10 minutes, daily.

Terminal Knee Extensions

Strengthens the muscles that straighten the knee.

What it helps: Trains the quad to lock the knee out fully straight — the strength you rely on every time you stand and step.

1. Loop a band behind your knee.
2. Straighten the knee against the band.
3. Return slowly.

Commonly done as 2-3 sets of 10-15, once or twice a day.

Short Arc Quad

Strengthens the muscle that straightens the knee.

What it helps: Strengthens the quadriceps that straighten your knee — the muscle that keeps the knee stable and stops it buckling under you.

1. Lie on your back with a rolled towel or foam roll under your thigh.
2. Straighten your knee by lifting your foot, keeping the thigh resting on the roll.
3. Hold briefly, then lower slowly.

Tips:

• Keep the back of your thigh on the roll throughout.

Commonly done as 20 repetitions, 1-2x daily.

Patellar Mobilization

Keeps the kneecap gliding freely so it does not tether and limit movement.

What it helps: Stops the kneecap becoming tethered by scar tissue after surgery. A kneecap that does not glide blocks both full straightening and full bending, so this quietly protects the range of motion you are working for.

1. Sit with your leg out straight and the thigh muscles completely relaxed.
2. Place your thumb and fingers on the edges of your kneecap.
3. Glide it gently toward the inside of the knee, hold briefly, then toward the outside.
4. Then glide it gently upward toward the thigh, and downward toward the shin.
5. Move slowly and only as far as it goes easily.

Tips:

• The thigh must be relaxed. A tightened quadriceps locks the kneecap and nothing will move.
• This should feel like a gentle stretch, not a struggle — the movement available is small.
• Easiest done straight after a shower when the tissues are warm.

Commonly done as 2 sets of 10 in each direction, daily.

Side-Lying Hip Abduction

Strengthens the muscles on the side of the hip.

What it helps: Loads the side-hip muscles a step harder, building the strength that keeps your hip level and takes pressure off the joint on stairs and longer walks.

1. Lie on your side with the bottom leg bent for support.
2. Keep the top leg straight and raise it toward the ceiling.
3. Hold briefly, then lower slowly.

Tips:

• Keep your toes pointing forward, not up.

Commonly done as 2-3 sets of 10-15, daily.

Seated Knee Extensions

Keeps the thigh strong while you stay off the foot.

What it helps: Keeps the thigh strong and the knee straightening well while you stay off your feet.

1. Sit in a chair with your foot supported.
2. Straighten your knee, lifting the lower leg.
3. Lower slowly.

Tips:

• Keep the movement at the knee, not the ankle.

Commonly done as 2-3 sets of 10, once or twice a day.

Core Activation

Gentle core engagement to support posture and balance while you recover.

What it helps: Switches on the deep core muscles that stabilize your pelvis and spine, giving your hips a solid platform to move from.

1. Lie or sit comfortably.
2. Gently draw your belly button toward your spine.
3. Hold a few seconds while breathing normally, then relax.

Tips:

• Avoid holding your breath.

Commonly done as 2-3 sets of 10, daily.

Sit-to-Stand

Builds the strength and confidence to rise from a chair.

What it helps: Trains the exact strength you use to rise from a chair, a toilet, or a car. Stronger here means more independence and less of a struggle on tough days.

1. Sit at the edge of a sturdy chair.
2. Lean slightly forward and stand up.
3. Lower yourself back down with control.

Tips:

• Use your arms for support as needed.

Commonly done as 2-3 sets of 8-10, once or twice a day.

Walking Program

Short, frequent walks build endurance and confidence.

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tips:

• Use your assistive device as directed.

Commonly done throughout the day.

Mini Squats

Builds leg strength through a comfortable range.

What it helps: Builds hip and leg strength through a comfortable range, so everyday moves — sitting, standing, bending — take less out of your joints.

1. Stand holding a counter.
2. Bend your knees a small amount, keeping them behind your toes.
3. Return to standing.

Commonly done as 2-3 sets of 10, once or twice a day.

Stationary Bike

Builds motion and endurance with low impact.

What it helps: Keeps the joints moving and nourished while you build endurance — all with no pounding. One of the gentlest ways to stay active when a joint is sore.

1. Set the seat so pedaling is comfortable.
2. Pedal at an easy pace.
3. Increase your time gradually.

Commonly done as directed.

Leg Press

Builds leg strength with adjustable resistance.

What it helps: Builds solid leg and hip strength with resistance you can dial precisely to your comfort.

1. Start with light resistance.
2. Press through your whole foot.
3. Return slowly.

Commonly done as 2-3 sets of 10-15, a few times a week.

Wall Sit

A steady hold that builds and calms the front-thigh (quad) muscles.

What it helps: Builds quad endurance in a steady hold, training the knee to support you through standing and stairs.

1. Stand with your back against a wall, feet shoulder-width apart and a step out from the wall.
2. Slide down until your knees are bent toward a comfortable, pain-free angle (don't go past 90°).
3. Hold the position, keeping your back against the wall and weight in your heels.
4. Slide back up to rest, then repeat.

Tips:

• Work in a range that doesn't sharpen the front-of-knee pain.
• Keep it steady — no bouncing; breathe normally through the hold.

Commonly done as hold 30–45s sets of 4–5 holds, most days.

Standing Hip Abduction

Strengthens the muscles on the side of the hip.

What it helps: Strengthens the outer-hip muscles that hold you steady whenever you're on one leg — which is every step you take. Stronger here, steadier hip.

1. Stand holding a counter for support.
2. Lift your leg out to the side, keeping it straight.
3. Lower slowly.

Tips:

• Keep your toes pointing forward.

Commonly done as 2-3 sets of 10-15, 1-2x daily.

Heel Raises

Strengthens the calf and improves balance.

What it helps: Strengthens the calf and steadies your balance, rebuilding the push-off that drives walking.

1. Stand holding a counter.
2. Rise up onto your toes.
3. Lower slowly.

Commonly done as 2-3 sets of 10-15, once or twice a day.

Single-Leg Balance

Improves balance and stability.

What it helps: Trains your hip and leg to stay steady when all your weight is on one side — which is most of walking. Better balance means a surer, more confident step.

1. Stand near a counter for safety.
2. Lift one foot and balance on the other leg.
3. Hold as able.

Commonly done daily.

Step-Ups

Builds strength for stairs and daily activity.

What it helps: Builds the leg and hip strength — and the control — for stairs, curbs, and everyday activity.

1. Step up onto a low step with your operative leg.
2. Step back down with control.

Tips:

• Hold a rail for balance.

Commonly done as 2-3 sets of 10, once or twice a day.

Step-Ups & Step-Downs

Advances stair strength and control.

What it helps: Advances your stair strength and the control to come down as confidently as you go up.

1. Step up onto a step, then step down slowly.
2. Control the lowering phase.

Tips:

• Hold a rail for balance.

Commonly done as 2-3 sets of 10, once or twice a day.

Box Squats

Strengthens the legs with a controlled depth.

What it helps: Builds leg strength to a controlled, comfortable depth — strength you can trust without overloading the joint.

1. Stand in front of a sturdy chair or box.
2. Lower until you lightly touch, then stand.

Tips:

• Keep good form throughout.

Commonly done as 2-3 sets of 10, a few times a week.

Lunges

Builds leg strength and control through a larger range.

What it helps: Builds leg and hip strength and control through a larger range, preparing you for more demanding activity.

1. Step forward into a comfortable lunge, lowering your back knee toward the floor.
2. Keep your front knee tracking over your foot.
3. Push back to standing.

Tips:

• Start shallow and progress the depth as strength allows.

Commonly done as 2-3 sets of 8-12, several times a week.

Balance & Proprioception Drills

Sharpens balance and joint awareness.

What it helps: Sharpens your sense of where your joints are in space — the control that keeps you steady and prevents missteps.

Commonly done a few times a week.

Resistance Band Side-Stepping

Strengthens the hips and ankles with side-to-side stepping against a band.

What it helps: Strengthens the side-hip muscles through movement, the way you actually use them — great for stability and a level stride.

1. Place a loop band around your legs (above the ankles or knees).
2. Step sideways against the band's resistance, keeping tension.
3. Step several times one way, then back.

Tips:

• Keep your steps controlled and your knees tracking forward.

Commonly done as 2-3 sets of 10 each way, several times a week.

Progressive Strengthening

Gradually increases strength as you recover.

What it helps: Gradually raises the challenge as you get stronger, so your body keeps adapting and improving rather than plateauing.

Commonly done as directed.

Elliptical Trainer

Low-impact cardio that is easy on the joints.

What it helps: Low-impact cardio that builds endurance and keeps the legs moving while staying easy on the joints.

Commonly done as able.

Swimming

Low-impact, full-body conditioning.

What it helps: Full-body conditioning with the water carrying your weight, so your muscles work hard with almost no load on the joints.

Commonly done as able.

Light Jogging Progression

Easing back into running with short, gentle jogging intervals once cleared.

What it helps: Eases you back into running with short, gentle intervals once you're cleared — letting the body adapt to impact gradually.

1. Begin with brief jog/walk intervals on a level surface.
2. Increase jogging time gradually as comfort allows.

Tips:

• Only begin once cleared; let any soreness guide your pace.

Commonly done as cleared.

Running Program

Structured return to running, building distance and pace over time.

What it helps: A structured return to running that builds distance and pace gradually, so the body keeps up with the load.

1. Progress from jog/walk intervals to continuous easy running.
2. Add distance before speed.

Tips:

• Build up gradually to protect the healing tendon.

Commonly done as cleared.

Agility Drills

Cutting, pivoting, and change-of-direction work for sport readiness.

What it helps: Rebuilds the quick cutting and change-of-direction control your body needs before returning to sport.

1. Practice controlled side-to-side and figure-eight movements.
2. Build speed gradually.

Tips:

• Start at submaximal effort and progress.

Commonly done as cleared.

Strength Training

Maintains and builds long-term strength.

What it helps: Builds and maintains long-term strength to keep you active, resilient, and independent.

Commonly done a few times a week.

Functional Strength Training

Task-based strengthening that rebuilds the movements of daily life and activity.

What it helps: Trains the real movements of daily life — lifting, carrying, squatting — with good mechanics, so everyday tasks feel easier.

1. Work through functional movements — squats, step-ups, lunges, and balance — as cleared.
2. Add resistance gradually.

Tips:

• Quality of movement first, then load.

Commonly done several times a week.

Core Strengthening

Supports posture and overall stability.

What it helps: Builds the core that holds your trunk steady, supporting your posture, your back, and everything you do on your feet.

1. Perform gentle core exercises as directed.

Commonly done a few times a week.

Cycling

Low-impact endurance and motion.

What it helps: Low-impact endurance that keeps the joints moving smoothly while you build fitness — easy on the body, good for the long run.

Commonly done as able.

Low-Impact Recreational Activities

Enjoyable activities that protect your joint.

What it helps: Getting back to the activities you enjoy in ways that are kind to your joints — the whole point of building this strength.

Commonly done as you like.