High Tibial Osteotomy (HTO) Rehab Protocol

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Phase 1 (0-6 weeks)

  • Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
  • Modalities: Compressive cyrotherapy, e-stimulation
  • Weightbearing: Non-weightbearing
  • Brace:
    • Locked in full extension at all times initial 48 hours (2 days).
    • ROM opened 0-90° from day-2 through 4 weeks
    • ROM opened to full, 0-120° weeks 4-6.
  • ROM:
    • First priority is to focus on regaining terminal extension.
    • Advance knee flexion ROM 5-10° daily as tolerated with goal of 90° within 2-3 weeks.
  • Exercises:
    • 0-2wks: Quad sets, SLR, calf pumps, passive leg hangs to 90° at home
    • 2-6wks: PROM/AAROM to tolerance, patella and tibiofibular joint mobs, quad, hamstring, and glute sets, SLR, side-lying hip and core

Phase 2 (6-8 weeks)

  • Weightbearing: *Guided by 6-week in-office radiographs. Call for clarity if not designated by physician.
    • Advance 25% weekly until full weightbearing. Instruct patient to recognize maladaptive gait.
  • Brace: Begin to wean from brace after 6 weeks. Advocate to continue in uncontrolled settings or adverse weather.
  • ROM: Full
  • Exercises: Advance phase 1 exercises. Progress weightbearing flexibility, begin toe raises and closed chain quad work. Begin floor-based core and gluteal work, balance exercises, hamstring curls and stationary bike.

Phase 3 (6-8 weeks)

  • Weightbearing: Advance 25% weekly and progress to full with normalized gait pattern
  • Brace: None
  • ROM: Full
  • Exercises: Advance closed chain quads, progress balance, core/pelvic and stability work. Begin stationary bike at 6 weeks. Advance SLR, floor based exercise; hip/core

Phase 4 (8-16 wks)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Progress flexibility/strengthening, progression of functional balance, core, glutes program. Advance bike, add elliptical at 12 weeks as tolerated. Swimming ok at 12 weeks.