Table 3.
Distal Femoral Osteotomy Postoperative Rehabilitation Protocol
| Week |
|||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 12 | 16 | 20 | 24 | 28 | 30 | 36 | |
| Initial exercises | |||||||||||||||||
| Flexion-extension | |||||||||||||||||
| Wall slides | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Seated | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Patellar tendon mobilization | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Extension mobilization | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Quadriceps series | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Hamstring sets | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Sit and reach for hamstrings (towel) | ● | ● | ● | ● | ● | ● | ● | ● | |||||||||
| Ankle pumps | ● | ● | ● | ● | ● | ● | ● | ● | ● | ||||||||
| Crutch weaning | ● | ● | ● | ||||||||||||||
| Toe and heel raises | ● | ● | ● | ||||||||||||||
| Balance series | ● | ● | ● | ● | ● | ||||||||||||
| Cardiovascular exercises | |||||||||||||||||
| Bike with both legs | |||||||||||||||||
| No resistance | ● | ● | ● | ||||||||||||||
| Resistance | ● | ● | ● | ● | ● | ● | |||||||||||
| Aqua jogging | ● | ● | ● | ● | ● | ● | |||||||||||
| Treadmill walking with 7% incline | ● | ● | ● | ||||||||||||||
| Swimming with fins | ● | ● | ● | ● | |||||||||||||
| Elliptical trainer | ● | ● | ● | ||||||||||||||
| Rowing | ● | ● | ● | ||||||||||||||
| Stair stepper | ● | ● | ● | ||||||||||||||
| Weight-bearing strength | |||||||||||||||||
| Double knee bends | ● | ● | ● | ||||||||||||||
| Double leg bridges | ● | ● | ● | ||||||||||||||
| Reverse lunge with static hold | ● | ● | ● | ||||||||||||||
| Beginning cord exercises | ● | ● | |||||||||||||||
| Balance squats | ● | ● | |||||||||||||||
| Single-leg dead lift | ● | ● | ● | ||||||||||||||
| Leg press | ● | ● | ● | ||||||||||||||
| Sports test exercises | ● | ● | |||||||||||||||
| Agility exercises | |||||||||||||||||
| Running progression | ● | ● | |||||||||||||||
| Initial—single plane | ● | ● | |||||||||||||||
| Advanced—multidirectional | ● | ||||||||||||||||
| Functional sports test | ● | ||||||||||||||||
| High-level activities | |||||||||||||||||
| Golf | ● | ● | |||||||||||||||
| Outdoor biking, hiking, snowshoeing | ● | ● | |||||||||||||||
| Skiing, basketball, tennis, football, soccer | ● | ||||||||||||||||
NOTE. A bullet point indicates that the patient should perform the listed exercise for that week. The range-of-motion restrictions were 0° to 90° for 2 weeks, followed by full passive range of motion. Regarding brace settings, an immobilizer was used for 8 weeks. Regarding weight-bearing status, progression to weight bearing was held until follow-up radiographic approval. The patient was non–weight bearing for 8 weeks and then progressed to one-fourth body weight per week to wean off crutches. The time lines were as follows: week 1, postoperative days 1 through 7; week 2, postoperative days 8 through 14; week 3, postoperative days 15 through 21; and week 4, postoperative days 22 through 28.