Tibial Tubercle Osteotomy
Rehabilitation Protocol

Pre-operative

Prepare for surgery

Maximize lower limb strength (focus on VMO and gluteal complex)
Educate on post-operative rehabilitation
Fit and educate on use of crutches

Weeks 0-2

Soft Tissue

Swelling reduction & regular icing (20 min. every 2-3 hours when awake)
Compression with short leg TED and double tubigrip to knee
Regular rest and elevation, encourage calf and quads contractions
Hamstring, calf and ITB stretches

Weight Bearing Status

Full weight Bearing in brace

Strengthening

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

ROM

Active and passive ROM within limitations of brace

Bracing

ROM Brace at all times expect when showering and sleep

Weeks 2-8

Soft Tissue

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

Weight Bearing Status

Full weight Bearing in brace

Strengthening

Active quad rehab

ROM Brace

Increase ROM Brace flexion limit by 10 degrees/week

Bracing

ROM Brace at all times except when showering and sleep

Weeks 8-12

Weight Bearing Status

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

Strengthening

Leg press and squat (0-60°), calf raises, hip abduction, hip adduction, hip flexor, HS curls, stationary bike
Address significant deficits e.g.. poor gluteal control, tight soft tissue structures, balance exercises
Commence eccentric WB quads sets once strength improving e.g. step ups
Progress to gym-focused program

Aerobic

Freestyle swimming initially with pool buoy then progress to kicking

Bracing

Discard ROM Brace

Weeks 12+

Soft Tissue

Progression of gym-based rehabilitation as above with increased resistance
Balance exercise to improve proprioception e.g. wobble board, mini tramp

Aerobic

Add elliptical trainer / stepper machine / rower machine
Swimming with flippers and road bike

6 months+

Sports-specific activities

No return to sport unless cleared by Dr Seeto Long term
AVOID LUNGES, DEEP SQUATS PAST 60°, HILL TRAINING to reduce PF contact shear forces
Return to sports highly dependent on severity of osteoarthritis

Do you need a

Knee replacement?

Dr Seeto in affiliation with Medibank Private and East Sydney Private hospital, offers a program for eligible Medibank Private Members, to eliminate medical out of pocket costs for your Knee Replacement.

The program includes a pre-surgery preparation program, spending the minimal time necessary in hospital, as well as home rehabilitation if necessary.