Rehabilitation protocol
Tibial Tubercle Osteotomy (TTO) Rehabilitation Protocol
The current rehabilitation protocol after a tibial tubercle osteotomy. 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 tibial tubercle osteotomy, in which the bony attachment of the patellar tendon is moved to address selected alignment, tracking, patellar-height, or cartilage-loading factors. When TTO is combined with MPFL reconstruction, the more protective restriction governs and the surgeon selects the combined plan. Distalization or other TTO variations, cartilage restoration, meniscus repair, ligament reconstruction, revision surgery, or an additional osteotomy may require different restrictions. Patients should use only the protocol identified by their surgical team.
What this protocol covers
- Rehabilitation after a tibial tubercle osteotomy, where realigned bone must heal before loading and motion advance.
- When TTO is combined with MPFL reconstruction, the more protective restriction governs — your surgeon selects the combined plan.
- Distalization or other TTO variations, and added cartilage, meniscus, ligament, revision, or osteotomy procedures, may follow different restrictions.
- Your surgical team selects the protocol — use only the one you are given, and follow your operative note and surgeon's instructions.
If you had a combined or different procedure
When a tibial tubercle osteotomy is combined with MPFL reconstruction, the more protective restriction governs and your surgeon selects the combined plan. Distalization or other TTO variations, cartilage restoration, meniscus repair, ligament reconstruction, revision surgery, or an additional osteotomy may require different weight-bearing, motion, strengthening, and return-to-activity restrictions. 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.
Osteotomy protection
The earliest period after surgery, focused on protecting the osteotomy and its fixation while the bone begins to heal, controlling pain and swelling, restoring full knee extension and quadriceps activation, and protected weight bearing within the limits your surgeon sets.
Protected loading and motion restoration
Once healing is confirmed, gradually progressing weight bearing toward a normalized gait and restoring motion, with progressive strengthening within healing and symptom limits.
Strength and movement control
Rebuilding strength, single-leg control, and low-impact conditioning as criteria are met, with a graded running program introduced only after healing is confirmed and the surgeon clears it.
Return to activity and sport
A criteria-based progression toward change-of-direction, plyometric, and sport-specific activity, decided with your surgeon and physical therapist. Recovery is individual 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.