Patellar Realignment — Patella Advancement with Distal Femoral Extension Osteotomy

Children's Colorado / Center for Gait and Movement Analysis (CGMA) · CGMA Physical Therapy Team, Children's Colorado

Weight-Bearing

Long leg/cylinder cast (knee ~20 deg flexion) x 3-6 weeks; protected WB x 3-6 weeks; NWB for transfers with immobilizers; CPM option; healing 6-8 weeks

Key Restrictions

PROM/AAROM 0-30 deg knee flexion x 1 week; 0-60 deg at week 2; 0-90 deg at week 3; no forceful/resistive quad contraction x 6 weeks; minimize fall risk; skeletally immature procedure requires more protection

Timeline & Phases

Phase 1 (days 1-7): 0-30 deg ROM, long sitting, isometrics, HEP; Phase 2 (days 8-21): 0-60 deg at wk 2 then 0-90 deg at wk 3, AAROM/AROM, mobility with immobilizer; Phase 3 (week 3+): scar mobility, knee extension in gait, progressive WB, ground reaction AFOs, full knee ROM, scar massage, e-stim; Phase 4 (week 7+): gait re-training, full LE ROM, LE strengthening (glutes/quads/calves), functional balance, return to pre-op

Notes

Pediatric; combined procedure (PT24 + PT23); indication is patella alta with fixed knee flexion contracture; tibial tubercle advancement or patellar tendon shortening + anterior femoral wedge removed; CPM option; Children's Colorado CGMA

Surgeon / Author

CGMA Physical Therapy Team, Children's Colorado

Published

June 2008