High tibial osteotomy (HTO)

Post-op recovery	First 2 weeks	Date
Goals	Protect the knee and surgical incision Recover from swelling and inflammation Control of post-surgical pain
Precautions	Non-weight bearing on crutches
Recommendations	Ice the knee up to 3 times a day – particularly in the first 72 hours Range of motion exercises of ankle Range of motion exercises of hip Increase flexion and extension of the knee as comfortable and as swelling allows
Suggested exercises	Static quads contraction Supine straight leg raise Ankle pumps Supine bed supported knee bend Sitting supported knee bend Sitting knee extension stretch – foot on floor Supine knee extension – foot elevated/supported

Phase 1	Week 2 to week 6
Goals	Achieve range of motion from 0-90 degrees Protect osteotomy site Gain control of leg
Precautions	Touch weight bearing with crutches
Recommendation	Hip and gluteal muscle strengthening Ankle range of motion.
Suggested exercises	Static quads contraction Supine straight leg raise Ankle pumps Supine bed supported knee bend Sitting supported knee bend Supine knee extension – foot elevated/supported Sitting knee extension stretch – foot on floor Side leg raise – knee straight, knee flexed

Phase 2	Week 7 to week 12
Goals	Comfortably walk normally Gain full range of motion Strengthen
Precautions	No running No deep squats, jumping or impaction activities
Recommendations	Gradually begin taking weight through your leg when you walk. Fully weight bear as able Discard crutches when walking safely Strengthen gluts, abductors, core Ankle and calf strengthening Passively stretch knee to full extension and full flexion Knee strengthening exercises Short walks
Suggested exercises	Double leg squats (0-90) Single leg squats Single leg hop Step ups – increase height Hop ups Step downs Resisted quads and hamstring resistance training Side leg raise – knee straight, knee flexed Gluteal band exercises Bridging with gluteal contraction Double calf raises – progress to single calf raise Exercycle – increase resistance and training length

Phase 3	3 Months – 6 months
Goals	Gain full function and strength
Precautions	Avoid collision sports or high risk recreational activity Return to vigorous activity as physiology allows (rapid return to rigorous strength training or endurance and speed training can lead to tendinopathies or injury)
Recommendations	Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, hamstrings and calves. Gain in confidence during athletic activity. Neuromuscular control and co-ordination of leg Long walks