Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.
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Knee · Realignment

High Tibial Osteotomy (HTO)

Post-operative protocol · Dr. Chris Vasileff, MD
For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

HTO (High Tibial Osteotomy) Rehabilitation Protocol

Phase I – Maximum Protection (0 to 1 week):

0 to 1 week:

  • Ice and modalities to reduce pain and inflammation
  • Use crutches toe touch weight bearing for 2 weeks, then PWB 50%, progress towards FWB 6 weeks.
  • Brace locked to 0 degrees until pt exhibits excellent quad control; brace can be unlocked to 90 degrees when there is good quad control and worn for the next 6 weeks.
  • Elevate the knee above the heart for the first 3 to 5 days
  • Initiate patella mobility drills
  • Begin full passive/active knee range of motion exercises
  • Quadriceps setting focusing on VMO restoration
  • Multi-plane open kinetic chain straight leg raising
  • Gait training with crutches

Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 6):

Weeks 1 to 6:

  • Maintain program as outlined in week 0 to 1
  • Wean out of brace starting at 6 weeks
  • Continue with modalities to control inflammation
  • Initiate global lower extremity stretching program
  • Begin stationary bike and pool exercise program (when incisions healed)
  • Implement reintegration exercises emphasizing core stability
  • Closed kinetic chain multi-plane hip strengthening on uninvolved side
  • Manual lower extremity PNF patterns
  • Proprioception drill emphasizing neuromuscular control
  • Multi-plane ankle strengthening

Phase III – Strengthening and Proprioceptive Phase (Weeks 6 to 12):

Weeks 6 to 12:

  • Normalize gait pattern
  • Advance stationary bike program; begin treadmill walking and elliptical trainer; no running and impact activity
  • Initiate closed kinetic chain exercises progressing bilateral to unilateral
  • Initiate proprioception/balance training

Phase IV – Advanced Strengthening (Weeks 12 to 24):

Weeks 12 to 16:

  • Initiate gym strengthening-beginning bilateral progressing to unilateral

Leg press, heel raises, hamstring curls, squats, lunges

Weeks 16 to 24:

  • Continue with advanced strengthening
  • Begin functional cord program

Phase V – Return to Sport/Functional Program (Week 24):

  • Follow-up examination with physician
  • Implement sport specific multi-directional drills
  • Continue with lower extremity strengthening, cardiovascular training, and flexibility
  • Sports test for return to play

RETURN TO ACTIVITIES

Running: 5-6 months when functional criteria are met

Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically

6-7+ months at earliest

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.