High Tibial and Distal Femoral Osteotomy Rehabilitation Protocol
STAGE
OBJECTIVE
TREATMENT DETAILS

Pre-operative

Prepare for surgery

Maximise lower limb strength (focus on VMO and gluteal complex)

Educate on post-operative rehabilitation; Fit and educate on use of crutches

Weeks 0-3

Soft Tissue

 

 

 

 

 

 

Weight Bearing Status

 

Strengthening

 

ROM

 

Bracing

Swelling reduction & regular icing (20 min. every 2-3 hours)

Compression with short leg TED and double tubigrip to knee, regular rest and elevation, encourage calf and quads contractions

Hamstring, calf and ITB stretches

Touch Weight Bearing (20%) with crutches                    OR ___________

 

Static and inner range knee contractions (0-30°), calf pumps, hip coronal and sagittal resistance exercises

 

Active and passive ROM (0-90°)

 

Usually not required                                                        OR ____________

Weeks 3-6

Soft Tissue

 

 

Weight Bearing Status

 

 

Strengthening

 

 

ROM

Daily scar massage

Foam roller for ITB (not for DFVO), gluteals, calf and HS releases

 

Partial Weight Bearing (50%) with crutches                       OR ___________

Commence walking in water at chest level

 

Commence stationary bike, low resistance leg press (0-45°)

Employ biofeedback when appropriate

 

Gradual restoration of full active and passive ROM

Weeks 6-12

Weight Bearing Status

 

 

 

Strengthening

 

 

 

 

 

Aerobic

Progress to Full Weight Bearing (once x-rays confirm bone union progressing and cleared by surgeon)

Discard crutches over 2-3 week period once balance and gait pattern normalizes

Gait re-training aiming to optimize knee extension, heel strike and toe off

 

Progress to gym-focused program Leg press and squat (0-60°), calf raises, hip abduction, hip adduction, hip flexor, HS curls, stationary bike

Commence eccentric WB quads sets once strength improving eg step ups

Address significant deficits eg poor gluteal control, tight soft tissue structures, balance exercises

No open chain exercises or deep lunges

 

Freestyle swimming initially with pool buoy then progress to kicking

Weeks 12+

Strengthening

 

 

Aerobic

Progression of gym-based rehabilitation as above with increased resistance

Balance exercise to improve proprioception eg wobble board, mini tramp

 

Add elliptical trainer / stepper machine / rower machine

Swimming with flippers and road bike

Months 6+

Sports-specific activities

No running or return to sport unless cleared by surgeon Note: Return to sports highly dependent on severity of osteoarthritis

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