High Tibial Osteotomy Rehab

HIGH TIBIAL OSTEOTOMY REHABILITATION PROTOCOL

This protocol was developed for patients who have had a high tibial osteotomy. Please note this protocol is a guideline. Patients with additional surgery will progress at different rates. Achieving the criteria of each phase should be emphasized more than the approximate duration.

PHASE I: ~0-2 WEEKs POSTOPERATIVE

GOALS:

• Pain/effusion control
• ROM—0 to 90 degreesAMBULATION, BRACING, AND DRESSING:
  Dressing – POD 1: Debulk dressing, TED Hose in place

  – POD 2: Change dressing, keep wound covered, continue TED Hose

  – POD 7-10: Sutures out, D/C TED Hose when effusion is resolved
  Brace – 0-90 degrees
  Crutches – Non weight bearing (NWB) x 6 weeks

  EXERCISES:
  CPM in hospital – 0-90 degrees
  AROM, AAROM 0-90 degrees
  Patellar mobilization (teach patient)
  Calf pumping
  Passive extension with heel on bolster or prone hangs
  Electrical stimulation with quad sets and SLR
  Quad sets, Co-contractions quads/hams
  Straight leg raise (SLR) x 4 on mat, in brace (parallel bars if poor quad control)
  Stretches – Hamstring, Hip flexors, ITB
  Ice pack with knee in full extension after exercise

PHASE II: ~2-4 WEEKS POSTOPERATIVE

GOALS:
• ROM 0-120 degrees• No extensor lag

AMBULATION AND BRACE USE: Brace – Open to available range Crutches – NWB

EXERCISES:
Scar mobilization when incision healed

Co-contractions quads/hamstring at 0, 30, 60, 90 degrees
SLR x 4 on mat, no brace – Add weight above knee if good quad control

Stationary bike for ROM

PHASE III: ~4-8 WEEKS POSTOPERATIVE

GOAL: FULL ROM

AMBULATION AND BRACE USE:
Brace – Open to available range
Crutches – NWB x 6wks then Partial weight bearing (PWB)
Continue appropriate previous exercises
PROM, AAROM, AROM to regain full motion
SLR x 4 on mat, no brace – Light weight below the knee
Weight shifts, Mini squats – In parallel bars
Leg press with light resistance
Hamstring curls – Carpet drags or rolling stool (closed chain)
Double leg heel raises
Stationary bike – Progressive resistance and time Pool therapy – Chest deep exercises in sagittal plane only

PHASE IV: ~8-12 WEEKS POSTOPERATIVE