Tibial plateau fracture
General Considerations
- Non-weightbearing status for 4 weeks post-op.
- Patients will be in a hinged brace for support and to serve as a reminder not to weight-bear
- Seek full hyperextension equal to opposite side.
- Regular manual treatment should be conducted to the patella and all incisions--with particular attention to the anterior medial portal--to decrease the incidence of fibrosis.
- Early recruitment of the vastus medialis muscle is important.
- No resisted leg extension machines (isotonic or isokinetic) at any point.
*Use the bone stimulator once per day (preferably at same time each day) for 30 minutes for 3 months.
*Use the CPM set at 0 to 50 degrees for 6 hours a day for 4 weeks.
Week 1
- M.D. visit day 1 post-op to change dressing and review home program.
- Icing and elevation frequently per instruction.
- CPM at home for 6 hours daily/at night.
Exercises
- Straight leg raise exercises (lying, seated, and standing), quadriceps/straight ahead plane only.
- No side-lying leg raises.
- Range of motion exercises.
- Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.
Manual
- Soft tissue treatments and gentle mobilization to posterior musculature and patella.
- Knee extension range of motion should be full.
Goals
- Decrease pain, edema.
- Range of motion 0-50 degrees or per MD.
- Gait non weightbearing X 4 weeks.
Weeks 2 - 4
- M.D. visit at 8 - 10 days for suture removal (if any) and check-up.
Exercises
- Continue with previous exercises.
- Nonweightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne arms only).
Manual
- Continue with pain control, range of motion, soft tissue treatments.
Goals
- Decrease pain, edema.
- Range of motion 0-50 degrees or per MD.
- Gait non weightbearing X 4 weeks.
Weeks 4 - 6
- M.D. visit at 4 weeks post-op, will progress to full weightbearing weaning down to 1 crutch, cane, or no assistive device.
Exercises
- Incorporate functional closed-chain exercises.
- Gait training.
- Balance/proprioception exercises.
- Road cycling as tolerated.
- Slow to rapid walking on treadmill (preferably a low-impact treadmill).
Manual
- Continue soft tissue treatment as needed, patellar glides; work towards full knee range of motion.
Goals
- Range of motion 0-130 degrees.
- Gait full weightbearing, focus mechanics.
Weeks 6 - 8
- Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines)
- Add lateral training exercises (side-stepping, Theraband resisted side-stepping)
Goals
- Gait without a limp.
- Full range of motion.
Weeks 8 - 12
- Patients should be pursuing a home program with emphasis on sport/activity-specific training
- Continue to push strength, endurance per tolerance.
Goals
- Initiate return to sport/activity- specific training.
NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.