Meet Our Physicians       Patient Education       Patient Registration       Post-Op Instructions       Special Precautions       Rehab Protocols       Links of Interest	Planning for Surgery Rehabilitation Protocol: TIBIAL TUBERCLE OSTEOTOMY PREOPERATIVE PHYSICAL THERAPY: Preoperative orientation visit, review protocol Gait train on crutches Instruction in home exercise program (SLR, Quad sets, short arc quads, ankle pumps, and heel slides) Instruction in ROM exercises, patellar mobilization, and proper icing techniques. Schedule first post-op physical therapy visit beginning 7-10 days after surgery. OUTPATIENT PHYSICAL THERAPY: Phase: Immediately post-op to 2 weeks Goals: To protect tubercle fixation, decrease effects of immobilization, control inflammation, normalize gait pattern, and achieve quads control, full extension, and flexion to 100º. Brace: Locked in full extension during sleep and ambulation. May unlock brace while seated or supine for ROM. Weight-bearing status: Limited to 5-10 lbs on operative side. Use crutches for ambulation. Therapeutic exercises: SLR (in supine, prone, and side-lying positions) with brace locked in full extension Active gravity resistance hamstring curls 0º to 90º Light patellar massage Quad-sets at full extension with EMS or biofeedback Ankle pumps with elevation Prone hangs Heel slides Non-weight bearing calf and hamstring stretches Seated/supine assisted flexion hangs Upper body cycling Phase: 2 to 6 weeks post-op Goals: Restore normal gait, full extension, full flexion, protect tubercle fixation, improve strength, endurance, and proprioception. Brace: Locked in full extension during sleep and ambulation. Weight-bearing status: Progress to WBAT. Discontinue crutches when gait is normalized, unless otherwise instructed. Therapeutic exercises: Continue patellar massage as needed Heel slides Continue prone hangs with progressive weights Continue multi-plane SLR add weights as tolerated Single-leg stance Seated and standing toe-raises Progress to weight bearing calf and hamstring stretches Begin stationary bike Continue hamstring curls with progressive weights Use EMS or biofeedback as indicated Continue upper body cycling Continue cryo cuff Proprioception training (BAPS board) at 4 weeks Lateral step-ups 1-2" at 4 weeks Wall sits to 70º, mini squats to 45º at 4 weeks Begin pool jogging in water vest at 4 weeks Phase: 6 weeks to 3 months Goals: To improve confidence in the knee, avoid overstressing the tubercle, protect the patellofemoral joint, progress strength, power, and proprioception. Brace: Progress to ambulation without brace if cleared by doctor. Therapeutic exercises: Continue lateral step-ups (progress 4-8" blocks) Add lunges if no PF issues Continue progressive weight hamstring curls Cross-country ski machine or elliptical stepper Continue flexibility exercises as appropriate for the patient Continue upper and lower body cycling Continue pool jogging/swimming Advance closed chain strengthening (one legged squats, leg press 0º to 60º) Lateral slide board at 8 weeks Begin straight ahead jogging at 10 weeks (if full ROM and no effusion) Add sport-specific activities (1/4 to ½ speed) To begin after 3 months: Crossovers Lateral steps 1-2 feet Box jumps Continue proprioception work Progress sport-specific activities to full speed Return to sports after 3 months if cleared by physician.