Patellar Realignment — Patella Advancement

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

Weight-Bearing

Protected WB in long leg/cylinder cast (knee ~20 deg flexion) x 3-6 weeks; NWB for transfers with knee immobilizers; CPM option (2-4 hr intervals); healing ~6 weeks

Key Restrictions

PROM/AAROM limited to 0-30 deg knee flexion x 1 week; 0-60 deg at week 2; 0-90 deg at week 3; no resistive/forceful quad contraction x 6 weeks; minimize fall risk; skeletally immature procedure (patellar tendon shortening) requires more protection than mature (tibial tubercle advancement)

Timeline & Phases

Phase 1 (days 1-7): 0-30 deg ROM, long sitting for hamstring stretch, isometrics (glutes/hamstrings/sub-max quads), HEP; Phase 2 (days 8-21): 0-60 deg at wk 2 then 0-90 deg at wk 3, AAROM/AROM, independent mobility with immobilizer; Phase 3 (week 3+): scar mobility, knee extension in gait/swing/stance, LE strengthening, no quad lag, MMT 3+/5 all LE groups, return to full activity ~3 months

Notes

Pediatric; indication is patella alta (spasticity) causing reduced quad force generation and extensor lag; skeletally mature: tibial tubercle advanced distally with hardware; skeletally immature: patellar tendon shortened with sutures; CPM option; Children's Colorado CGMA

Surgeon / Author

CGMA Physical Therapy Team, Children's Colorado

Published

June 2008