High Tibial Osteotomy (HTO) Rehabilitation Protocols

5 High Tibial Osteotomy (HTO) rehabilitation protocols from 5 institutions, published 2024–2025. Weight-bearing progressions vary by institution — compare them in the table below before selecting a protocol.

Compare by institution

Institution	Weight-Bearing	Key Restrictions
iOrtho	NWB/TDWB brace locked x4 wks; TDWB progressing to PWB wks 4-6; WBAT per MD based on X-ray	No active knee extension; no resisted exercise until 6 wks; no running/jumping/plyometrics until 4-6 months
Mammoth Orthopedic Institute / Sierra Park PT	TTWB until specific MD instructions to progress; PWB progressing to FWB with MD clearance…	TTWB until MD clearance; brace on at all times (day and sleep) x6 weeks, off only for hygiene; CPM 10 hrs/day…
NYU Langone Health	TTWB	TTWB w/ brace locked in extension 0-6 wks (including sleep); ROM goal 0-90 in Phase I; impact activity…
Saint Louis University (SLUCare) — HTO or Distal Femoral…	NWB in brace 2 weeks; 25-50% PWB in brace locked wks 2-6; WBAT wks 6-14; running at 4…	NWB in brace wks 1-2; brace locked in extension; no running/sport until week 14+; running criteria: extensor…
University of New Mexico (UNM) Sports Medicine — Knee…	Closing wedge: WBAT (may need crutches 2-6 wks); Opening wedge: 50% PWB x 6 weeks; Both…	Brace unlocked per surgeon-set arc x 6 weeks; no pivoting/twisting/hopping/jumping/running until 6 weeks…