Tibial Tubercle Osteotomy
Phase/
Time Frame
I
(0-3 weeks)
Weight
Bearing
PWB, may stand
in tandem for
short periods of
time
Brace
-Brace locked at
10-15
-Wear brace at all
times except
when doing CPM
or ROM ex
ROM
0- tolerance,
expect 90
progressively in
CPM
Therapeutic Exercise
Quad sets, ham sets,
ankle pumps, full
hyperextension-90
progressively in CPM,
4-way SLR in brace,
NMES/biofeedback
PRN
Phase I Precautions: Brace locked at 15; wear brace at all times except when doing CPM or ROM ex;
NO quad OKC at any point; wound healing
Phase I Goals: Quad set WNL; Emphasize full knee hyperextension; SLR without lag; full
hyperextension-90 ROM; resolve joint effusion
WB 50% or less
- open brace to
Full knee
Start 2-leg CKC with
using crutches to maximum
hyperextension brace on, SLR without
facilitate normal
flexion, gradually
lag (no brace if no lag),
gait pattern
open fully as
0-120 degrees
bike for ROM,
IIa
ROM progresses, progressively
proprioceptive
(3-6 weeks)
FWB with brace
as per quad
activities, core strength,
for short distances control
well leg ex’s
(ie
bedroom/bathroo -Wear brace at all
m/office)
times except
when doing CPM,
ROM ex,
showering
IIb
(6-8 weeks)
FWB in house
with brace on,
Continue PWB
50% when out
doors.
Brace fully open.
No brace
necessary for
sleeping.
FROM
Start one legged CKC
activity
Phase II Precautions: WB up to 50% based on pain/joint response, wear brace at all times except when
doing CPM or ROM ex
Phase II Goals: Full knee hyperextension  120 (progressively); progress proximal hip and core
strength
FWB with normal Only need brace
Restore
Progress CKC ex from
III *
for outdoors,
symmetrical,
2-leg to single,
(8-12 weeks) gait pattern
unknown
full AROM
progress proprioceptive
conditions, as per
and core
quad control and
motion
as PER MD okay pending Radiographic findings
Phase III Precautions: Proper alignment for squatting activities, no running or impact activities
Phase III Goals: restore symmetrical, full AROM; single-leg squat  60; single-leg stance  60 sec
FWB
IV
(12-16
weeks)
No brace per
surgeon
Full ROM
-Basic agility, limited
plyos, basic sport
specific activities.
- no dedicated running
-Progress cardio,
strength, proprio and
core PRN
Phase IV Precautions: Avoid technique and form breaks that lead to PF issues, correct landing/take off
mechanics.
Phase IV Goals: Gradual progression back to full non pounding activity based on symptom response and
demonstrated control and strength.
Phase V (16 wks +): Gradual progression back to full activity based on symptom response and
demonstrated control and strength.
Recreational Running and unlimited plyos after 4 months when cleared by MD pending XR findings
References:
UMP: Dr. Elizabeth Arendt
UMP PT department
Revised 04/2011