“DR. TREVOR” STEFANSKI, M.D.
Minimally Invasive Specialist
Tibial Plateau Fracture Surgery
Physical Therapy Protocol
Tibial Plateau Fracture: Open Reduction Internal Fixation (ORIF)

Tibial Plateau Fracture: Open Reduction Internal Fixation (ORIF)

Physical Therapy Protocol

Phase I – Maximum Protection (0 to 1 Week)

0 to 1 Week:

  • Ice and modalities to reduce pain and inflammation.
  • Non-weight bearing (NWB) with crutches for 12 weeks.
  • Brace in full extension except during therapy sessions.
  • Elevate the leg above the heart for the first 3 to 5 days.
  • Patella mobility drills.
  • Gait training focusing on NWB restoration.

Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 6)

Weeks 1 to 6:

  • Continue with the program outlined in Phase I.
  • Use modalities to control inflammation.
  • Begin gentle range of motion (ROM), goal to exceed 90° of knee flexion by 4 weeks.
  • Closed kinetic chain multi-plane hip strengthening on the uninvolved side.
  • Proprioception drills emphasizing neuromuscular control.
  • Multi-plane ankle strengthening.

Phase III – Strengthening and Proprioceptive Phase (Weeks 6 to 12)

Weeks 6 to 12:

  • Modalities as needed.
  • Continue with Phase II exercises as indicated.
  • Emphasis on achieving and maintaining full ROM.
  • Begin stationary bike and light strengthening exercises.
  • Initiate weight-bearing as tolerated, progressing gradually.

Phase IV – Advanced Strengthening and Initiation of Plyometric Drills (Weeks 12 to 20)

Weeks 12 and Onward:

  • Begin partial weight bearing at 25% of body weight and increase by 25% per week.
  • Gradually progress to one crutch as tolerated, eventually weaning off crutches.
  • Normalize gait pattern once bearing full weight.
  • Initiate closed kinetic chain exercises progressing from bilateral to unilateral movements.
  • Begin proprioceptive training exercises.

Phase V – Full Return to Activity (Weeks 20 and Beyond)

Weeks 20 and Onward:

  • Full return to activity as tolerated.
  • Continue strengthening and proprioceptive exercises.
  • Begin sport-specific drills and progressive load-bearing exercises.

Patient Education

  • Emphasize the importance of following the weight-bearing guidelines to avoid complications.
  • Instruct patients on proper bracing, gait training, and how to manage swelling with elevation and cryotherapy.
  • Educate on gradual return to activity, with a focus on avoiding high-impact activities until cleared.

Red Flags

  • Unusual pain, increased swelling, or discomfort should be reported to the healthcare provider.
  • Any difficulties with weight-bearing progression or abnormal gait pattern should be addressed immediately.
  • Persistent or increasing joint stiffness, particularly after the 12-week mark, should be evaluated for potential complications.