Rehabilitation protocol
Knee Realignment Osteotomy Rehabilitation Protocol
The current rehabilitation protocol after a knee realignment osteotomy — a distal femoral osteotomy (DFO) or a high tibial osteotomy (HTO). Because bone is realigned and must heal, early recovery is protective and progression is guided by healing. Your surgeon and physical therapist will tailor it to you — always follow the individualized plan they give you, and use only the protocol your surgical team selected.
Who this protocol is for
Applies to distal femoral osteotomy (DFO) and high tibial osteotomy (HTO), in which bone is realigned and must heal. It does NOT apply to tibial tubercle osteotomy and does NOT apply to another osteotomy unless the surgical team specifically directs use of this protocol. When a realignment osteotomy is combined with other procedures, the surgeon-selected combined plan is used and the most protective applicable restrictions govern. The operative note and surgeon-selected protocol take precedence, and patients should use only the protocol identified by their surgical team.
What this protocol covers
- Rehabilitation after a knee realignment osteotomy — distal femoral osteotomy (DFO) or high tibial osteotomy (HTO) — where realigned bone must heal before loading and motion advance.
- It does NOT apply to a tibial tubercle osteotomy or to another osteotomy unless your surgical team specifically directs use of this protocol.
- Return to sport is criteria-based and requires radiographic healing, at least 90% isokinetic strength compared with the other leg, and physician clearance; a general expectation is around 5–6+ months, which is not a guarantee.
- For combined procedures, the surgeon-selected combined plan is used and the most protective applicable restrictions govern — follow your operative note and surgeon's instructions, and use only the protocol you are given.
If you had a combined or different procedure
This protocol applies to a distal femoral osteotomy (DFO) or a high tibial osteotomy (HTO). It does not apply to a tibial tubercle osteotomy or to another osteotomy unless your surgical team specifically directs it. When a realignment osteotomy is combined with other procedures, your surgeon selects the combined plan and the most protective applicable restrictions govern. This protocol never substitutes for your operative note or the plan your surgeon selected — follow the individualized instructions your surgical team gives you.
How rehabilitation is generally structured
Rehabilitation after this procedure is usually organized into progressive phases. The phases below describe the general shape only — specific exercises, precautions, and timelines are individual and are set by your surgeon and physical therapist.
Immediate postoperative / period of protection
The earliest period after surgery, focused on protecting the healing osteotomy and its fixation, controlling pain and swelling, restoring knee extension and quadriceps activation, and protected weight bearing and motion within the limits your surgeon sets.
Transitional phase — low impact
As healing is confirmed, progressing toward full weight bearing and a normalized gait and restoring full, symmetrical motion, with progressive low-impact strengthening and conditioning within healing and symptom limits.
Intermediate phase — linear
Advancing strengthening and control, with a linear running program introduced only when criteria are met, radiographic healing is confirmed, and the surgeon clears it.
Return to activity — high impact
A criteria-based progression toward sport-specific, higher-impact activity. Return to sport requires radiographic healing, at least 90% isokinetic strength compared with the other leg, and physician clearance; a general expectation is around 5–6+ months, which is not a guarantee and is commonly longer when other procedures were performed at the same time.
This overview describes the general structure of rehabilitation only. It does not replace the specific instructions of your own surgeon and physical therapist, whose guidance always takes precedence. Timelines and precautions are individual and are set for you at your appointments. Use only the protocol your surgical team selected for you.