Tibial tubercle transfer

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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
  • Brace locked in full extension

 

Recommendations

  • At rest the brace can be loosened to allow swelling and discomfort to settle
  • Ice the knee up to 3 times a day – particularly in the first 72 hours
  • Sleep in the brace
  • Range of motion exercises of ankle
  • Range of motion exercises of hip

 

Suggested exercises

  • Static quads contraction
  • Side leg raise
  • Flexion, extension and abduction of hip – standing supported (non weight-bearing)
  • Supine knee extension – foot elevated/supported
  • Ankle pumps

 

Phase 1 Week 2 to week 6

Goals

  • Achieve range of motion from 0-90 degrees

 

Precautions

  • Touch weight bearing with crutches
  • No quads strengthening

 

Brace

  • Week 3 – week 4  Brace set at 0-90 degrees flexion
  • Week 5 – week 6 Brace unlocked
  • Brace can come off for sleep after week 4
  • At rest the brace can be loosened to allow swelling and discomfort to settle

 

Recommendation

  • Gradual increase in range of motion of knee – passive only, no strenthening
  • Hip and gluteal muscle strengthening
  • Ankle range of motion.

 

Suggested exercises

  • Static quads contraction
  • 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

 

Precautions

  • Brace can be removed

 

Recommendations

  • Gradually begin taking weight through your leg when you walk. Fully weight bear as able
  • Discard crutches when walking safely
  • Avoid resisted strength training (lifting weights) with your quadriceps. Extending with the weight of your own leg is acceptable
  • Hip and gluteal strengthening
  • Ankle and calf strengthening
  • Passively stretch knee to full extension and full flexion
  • Short walks
  • No running

 

Suggested exercises

  • Supine straight leg raise
  • Standing knee extension
  • Sitting unsupported knee extension and flexion
  • Single leg stance – knee straight, knee flexed
  • Double calf raises
  • Side leg raise – knee straight, knee flexed
  • Gluteal band exercises
  • Exercycle – low resistance, short interval

 

Phase 3 3 Months – 6 months

Goals

  • Gain full function and strength

 

Precautions

  • Avoid collision sports or high risk recreational activity
  • Return to vigorous athletic 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
  • Return to running in sensible progressive time frame

 

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 weight 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

 

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