Tibial Tubercle Transfer
Phase I – Maximum Protection (Weeks 0 to 6):
0 to 2 weeks:
Brace locked in full extension for 6 weeks
PWB first 2 weeks then WBAT in brace
Ice and modalities to reduce pain and inflammation
Aggressive patellar mobility drills
Range of motion – 0*to 45* knee flexion
Begin quadriceps setting- when pt can perform strong QS, start with SLR without a quad lag; begin hip abduction and hip extension when pt masters SLR w/out lag.
Weeks 2 to 4:
Continue with inflammation control
Continue with aggressive patellar mobility
Range of motion – 0* to 60*
Continue with submaximal quadriceps setting, isometric hamstring/groin and global lower leg strengthening
Weeks 4 to 6:
Progressive weight bearing per physician’s instructions
Continue with ice and aggressive patellar mobility
Range of motion – 0* to 90* (by week 6)
Increase intensity with quadriceps setting
Phase II – Progressive Range of Motion and Early Strengthening (Weeks 6 to 12):
Weeks 6 to 8:
Full weight bearing
Open brace to 45*- 60* of flexion week 6, 90* at week 7
Continue with swelling control and patellar mobility
Gradually progress to full range of motion
Begin multi-plane straight leg raising and closed kinetic chain strengthening program focusing on quality VMO function.
Initiate open kinetic chain progressing to closed kinetic chain multi-plane hip strengthening
Normalize gait pattern
Begin stationary bike
Initiate pool program
Weeks 8 to 10:
Wean out of brace
Continue with patellar mobility drills
Normalize gait pattern
Restore full ROM
Progress open and closed kinetic chain program from bilateral to unilateral
Increase intensity on stationary bike
Begin treadmill walking program
Weeks 10 to 12:
Full ROM
Aggressive terminal quadriceps stretching
Advance unilateral open and closed kinetic chain strengthening
Initiate proprioception drills
May introduce elliptical trainer
Phase III – Progressive Strengthening (Weeks 12 to 16):
Weeks 12 to 16:
Advance open and closed kinetic chain strengthening
Increase intensity on bike, treadmill, and elliptical trainer
Increase difficulty and intensity on proprioception drills
Begin gym strengthening: leg press, hamstring curls, ab/adduction; avoid lunges and knee extensions
Begin multi-directional functional cord program
Initiate pool running program
Phase IV – Advanced Strengthening & Functional Drills (Weeks 16 to 20):
Weeks 16 to 20:
Continue pool running program advancing to land as tolerated
Phase V – Plyometric Drills and Return to Sport Phase (Weeks 20 to 24):
Weeks 20 to 24:
Advance gym strengthening
Progress running/sprinting program
Begin multi-directional field/court drills
Begin bilateral progressing to unilateral plyometric drills
Follow-up appointment with physician
Sports test for return to competition 6 months post-op per physician’s release
RETURN TO ACTIVITIES
Running: 4-5 months when functional criteria are met
Golf: Short irons at 4 months, full swing with long irons at 5 months.
Delay 4-6 weeks if lead leg.
Pivoting/cutting sport: When functional criteria are met and cleared by surgeon, typically
7+ months at earliest