First Phase (up to 6 weeks)
This is directed at regaining range of movement and reducing the swelling combined with patella femoral mobilisation to reduce scar tissue.
Knee Brace: The knee brace should be used at all times when moving around for the first 6 weeks to protect the osteotomy site. For the first 3 weeks it is best for comfort reasons to lock the hinges when moving around but after 3 weeks it is safe to leave the hinges unlocked to help regain free bending of the knee. The brace may be removed at night as comfort and confidence allows.
Weight bearing: Weight bearing as tolerated is allowed in the brace with the aid of crutches and it is usual to use the crutches for the first 6 WEEKS.
Exercises: Early physiotherapy is directed at static quadriceps and hamstring work maintaining muscle bulk. Range of movement exercises aim to achieve a comfortable 90 degrees bend and full straightening (extension) of the knee by 3 weeks and nearly full flexion by 6 weeks.
Exercises allowed up to six weeks include supine knee flexion exercises sliding heel on a bed or board (closed chain exercises only), spinning on a bike without load, patella mobilisation (superior, inferior and medial/lateral), straight leg raising and static quadriceps/hamstring exercises. 90º flexion is expected by three weeks and 110º by six weeks. Further flexion can be pushed after six weeks assuming the bone has healed.
Exercises that are not advised before six weeks include bridging, prone lying with forced knee flexion, open chain extension exercises over a towel and anything putting excessive load across the osteotomy. In the position of prone lying the weight of the tibia is too excessive for the torsional loads on the plate and this position must be avoided.