Anteromedialization (AMZ) or Tibial Tubercle Osteotomy (TTO) Rehabilitation Protocol

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Phase 1 (0-2wks):

  • Weight bearing: NWB
  • Brace: Worn at all times, remove for hygiene and exercises
  • ROM: Focus on gaining terminal extension
    • Locked in extension for initial 48 hours after surgery
    • ROM opened 0-90° after 48 hours
  • Exercises: Calf pumps, quad sets, SLR in brace, modalities

Phase 2 (2-6wks)

  • Weight bearing: TTWB
  • Brace: May be removed at night.
  • ROM: Maintain full extension and advance knee flexion ROM
    • Brace ROM 0-90° degrees weeks 2-4.
    • Brace opened to full ROM 0-120° weeks 4-6.
  • Exercises: Progress NWB flexibility, begin floor-based core, hip and gluteal work, advance quadriceps sets, patellar mobilizations and SLRs.

Phase 3 (6-8wks)

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

Phase 4 (8-16wks)

  • Weightbearing: Full
  • Brace: None
  • ROM: Full
  • Exercises: Progress flexibility and strengthening, progression of functional balance, core, glutes program; advance bike after 12wks; outdoor cycling, elliptical, swimming after 12wks

Phase 5 (16-24wks)

  • Weightbearing:Full
  • Brace: None
  • ROM: Full
  • Exercises: Maximize single leg dynamic and static balance; glutes/pelvic stability/core + closed chain quad program and HEP independent; Begin training sport specific drills as tolerated after 16wks once cleared by MD