SPORTS MEDICINE SERVICE
High Tibial or Femoral Osteotomy
General Guidelines
- No closed chain exercises for 6 weeks
- Rehabilitation protocol is the same for femoral or tibial osteotomy
- Rehabilitation for the ACL reconstruction combined with high tibial osteomyis dictated by the osteotomy protocol
- Supervised physical therapy takes place for 3-6 months post-operatively
GeneralProgression of Activities of Daily Living
- Bathing and showering after suture removal
- Sleep with brace locked in extension for 4 weeks
- Driving at 6 weeks post-op
- Brace locked in extension for 4 weeks for ambulation
- Use of crutches 6-8 weeks post-op
- Weight-bearing as tolerated with brace locked in extension for first 4 weeks
Rehabilitation Progression: General Guidelines
Phase I (First 4 weeks)
Goals:
- Protect fixation and surrounding soft tissue.
- Control inflammation
- Minimize adverse effects of immobilization through CPM device and heel slides 0-90 degrees of flexion
Brace Locked in full extension aside from CPM and physical therapy
Weight Bearing As tolerated with two crutches
Therapuetic Exercise
- Quad sets
- Ankle pumps
- Heel slides 0-90 degrees of flexion
- CPM for 2 hours day 0-90 degrees of flexion
- Non-weight-bearing calf, hamstring stretches
- SLR in four planes with brace
- Resisted plantar flexion with theraband
Phase II (4 -6 weeks post-op)
Criteria to advance
- Good quad set
- Approximately 90 degrees of flexion
- No signs of active inflammation
Goals
- Increase range of motion
- Avoid overstressing fixation
- Increase quadriceps strength
Brace Unlocked for ambulation
Weight Bearing Status As tolerated with two crutches
Therapuetic Exercise
- Continue range of motion exercises progressing towards full flexion
- Discontinue CPM once 90 degrees attained
- Initiate aquatic therapy if available
- Remove brace for SLR, must be able to maintain full extension
- Initiate stationary bike, low resistance
Phase III (6 weeks – 3 months)
Criteria to advance
- Good quadriceps tone and no extension lag with SLR
- Full extension
- Flexion 90-100 degrees
Brace Discontinue at 6 weeks unless otherwise directed
Weight bearing status As tolerated unless otherwise directed
Therapuetic Exercise
- Mini-squats 0-45 degrees, progressing to step-ups
- 4 way hip for flexion, extension, adduction, abduction
- stationary bike with moderate resistance
- Leg press 0-60 degrees of flexion. Closed chain kinetic chain terminal knee extension with resistive tubing/weights
- Toe raises
- Balance exercises
- Hamstring curls
Phase IV (3 months- 9 months)
Criteria for advancement
- Good –Normal quadriceps tone
- No soft tissue complaints
- Normal gait pattern
Goals
- Continued improvements in quadriceps strength
- Improve functional strength and proprioceprtion
- Return to modified activities
Therapuetic Exercise
- Progression of closed kinetic chain activities
- Treadmill walking
- Swimming
- Jogging
- Sport-specific activities