This bone portion is then mobilized in a position Post-op Rehabilitation Protocol Tibial Tubercle Osteotomy . The treatment of patients with tibial tubercle avulsion fractures depends on the fracture pattern; it can be conservative with immobilization in a long leg cast in extension for 6 weeks with minimal displacement (< 2 mm) and/or acceptable displacement after closed reduction/cast application. -, Bell R, Jimenez AE, Levy BJ, et al. See this image and copyright information in PMC, Arundale AJH, Capin JJ, Zarzycki R, Smith A, Snyder-Mackler L. Functional and patient-reported outcomes improve over the course of rehabilitation: a secondary analysis of the ACL-SPORTS trial. Patellar tracking can be tested during the physical examination. WebApril 26th, 2018 - Tibial Plateau Fracture JB Tibial Rod Post Tibia Fracture Rehab Protocol Duration physical therapy guru self tibial glide Duration Tibial Plateau Fracture Post Operative Protocol May 7th, 2018 - 900 Round Valley Drive Suite 100 Park City UT 84060 Telephone 435 655 6600 Fax 435 655 2388 Tibial Plateau Fracture Post Careers. It serves as a resource guide for physical therapy accelerated rehabilitation; patellar instability; patient outcomes; tibial tubercle osteotomy. Phase 1 (Weeks 0-2): Goals: Minimize effusion, Progress range of motion, Utilize brace . Weber/AO categorizes fractures on level of the fibular fracture. Diffuse tenderness along the posterior medial tibia to the middle and distal third is the hallmark of MTSS. 8600 Rockville Pike ACL PATELLAR TENDON ALLOGRAFT RECONSTRUCTION. The Q-angle (quadriceps angle) is a measurement that describes the alignment of the patella with respect to the tibia and femur. ORIF TIBIAL TUBERCLE PROTOCOL I. Epidemiology, Diagnosis, and Management of Tibial Tubercle Avulsion Fractures in Adolescents. government site. The intent of this protocol is to not to supplant the decision making They often occur in male adolescent athletes, usually in relation with sports involving powerful jumps. A more accelerated rehabilitation protocol allowing for early weightbearing Rehabilitation Protocol: Tibial Tubercle Transfer Phase I (Weeks 0-2) Bracing: Hinged knee brace locked in extension for a total of 6 weeks (including during sleeping). Salari N, Horsmon G, Cosgarea A. Keywords: Treatment plan: Bilateral Tibial Tubercle Avulsion Fractures in Children - Clinical Results of a Rare Fracture. This systematic approach to the physical examination is useful for the peripheral nervous system and vascular system so pertinent details are not missed. Isolated midshaft or proximal fibula fracture- Immobilization in a long leg cast generally is not required. -, Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA. Finite element study of the effects of fragment shape and screw configuration on the mechanical behavior of tibial tubercle osteotomy. If a line is drawn along the long axis of the femur to the center of the patella, and another line is drawn from the center of the patella to the insertion of the patellar tendon to the tibia (tibial tubercle), then an angle is formed called the Q-angle. CPT, Current Procedure Terminology; TTO, tibial tubercle osteotomy. Fernandez Fernandez F, Eberhardt O, Schrter S, Wirth T, Ihle C. Z Orthop Unfall. The outcome was excellent after a 12-week rehabilitation protocol. ACL REVISION STAGE 1. General accelerated postoperative rehabilitation program after tibial tubercle osteotomy. Continue with swelling control and patellar mobility. 2017;18(1):73. This site needs JavaScript to work properly. The site is secure. The knee joint is composed of two distinctly separate articulations. Recovery and If this condition is suspected, Dr. Gill may order x-rays of your knee that will show the position of the patella in the trochlear groove. Gradually progress to full range of motion. -. creates a fulcrum that increases the mechanical efficiency of the action of the quadriceps muscles. An official website of the United States government. FOIA Tibial tubercle osteotomy can modify tracking and/or patellofemoral contact forces to effect the unloading of chondral defects of the patella or trochlea, correct multiplanar CONSORT (Consolidated Standards of Reporting, CONSORT (Consolidated Standards of Reporting Trials) flowchart. Careers. ACL & POSTEROLATERAL CORNER RECONSTRUCTION. initial treatment usually involves decreased physical activity, formal physical therapy with specific stretching and strengthening protocols for the quadriceps and hamstring 2004, Knee Surgery, Sports Traumatology, Arthroscopy. The piece of bone is reattached to the tibia using two screws. Case series; Level of evidence, 4. After surgery a knee brace is worn to protect the knee for about six weeks until the bone is healed. Bethesda, MD 20894, Web Policies has received consulting fees from Medical Device Business Services, speaking fees from Arthrex, and honoraria from the Musculoskeletal Transplant Foundation. WebA surgical fracture is made in the proximal tibia. The patella can partially dislocate (subluxate) or completely dislocate from a direct sideways blow to the knee or if the Q-angle temporarily increases too much due to outward rotation of the leg and foot (such as when pivoting). MPFL, medial patellofemoral ligament. Would you like email updates of new search results? Knee. Web16. 2018;19(1):250. We present a Boston Sports Medicine & Research Institute 2014. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS5]). Khoriati AA, Guo S, Thakrar R, Deol RS, Shah KY. -, Chang CW, Chen YN, Li CT, et al. A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 12.57 years were included in the final analysis. If the fracture is non-displaced, or if Giving to Boston Sports Medicine and Research Institute, Laboratory for Musculoskeletal Tissue Engineering. Gigante A, Setaro N, Rotini M, Finzi SS, Marinelli M. Injury. Use of a superolateral portal and 70 degrees arthroscope to optimize visualization of patellofemoral tracking and osteochondral lesions in patients with recurrent patellar instability. The goals of treatment, therefore, are to restore continuity of the Unable to load your collection due to an error, Unable to load your delegates due to an error. Current Procedural Terminology (CPT) code 27540 for open treatment of intercondylar spine (s) and/or tuberosity fracture (s) of the knee was used to identify patients treated for tibial tuberosity fractures in our institution between 2000 and August 2019. Purpose: 1995;81(7):635-8. Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Lateral tracking over a long period of time, injury and other factors may cause breakdown of the patellofemoral joint surfaces. Study design: The .gov means its official. When inspecting neurovascular structures, the physical examination is the primary initial clinical assessment. Or it can be surgical. Tibial Spine Avulsion Fracture Rehabilitation Guidelines The intent of this protocol is to provide guidelines for progression of rehabilitation and is not intended to serve as a substitution for 1995. Our purpose is to present the case report of an adolescent basketball player with such an avulsion fracture who was treated operatively, his clinical and surgical courses of treatment, and his eventual outcome. Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. Dr. Gill may ask you to extend (straighten) your knee while he holds your tibia first rotated inward then rotated outward. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. This site needs JavaScript to work properly. Knee Surgery, Sports Traumatology, Arthroscopy. Imaging of sports-related muscle injuries, Hip Pain in a High School Football Player: A Case Report, How To Treat Series: Sports Injuries in Children, Current Concepts in the Recognition and Treatment of Posterolateral Corner Injuries of the Knee, PPM MayJune06 Pinzon-Chronic Sports Injures, Hamstring injuries: anatomy, imaging, and intervention, Simultaneous Rupture of Patella Tendon With Tibial Tubercle Avulsion Fracture, Anterior Cruciate Ligament Avulsion Fracture of the Tibial Spine in a Skeletally Mature Patient: A Case Report, Physical Medicine and Rehabilitation Board Review.pdf, Fundamental Orthopedic Management for the Physical Therapist Assistant. Rev Chir Orthop Reparatrice Appar Mot. The quadriceps muscles in the front of the thigh attach to the patella and continue via the patellar tendon to insert into the tibia. ACL Patellar Tendon Autograft Reconstruction. WebOr it can be surgical. Non-operative treatment consists of the following: Bracing and lateral knee supports to help hold the patella in place. Epub 2019 Sep 19. WebPhysiotherapy and rehabilitation during the distal to the tibial tuberosity with a high riding patella. ACL Quadriceps Autograft Reconsturction. The patellofemoral joint is formed by the kneecap (patella) gliding along a groove (trochlea) of the femur. MeSH Unable to load your collection due to an error, Unable to load your delegates due to an error. Accessibility Rev Chir Orthop Reparatrice Appar Mot. Accessibility Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67 32.65 vs 131.12 9.02, respectively; P = .022). Arthrosc Tech. and transmitted securely. Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. We present a retrospective study of 10 patients, with an average age of 15.1 years, all of them males, and a total of 11 acute avulsions of the anterior tibial tubercle. Distal re-alignment consist of making a small incision over the upper tibia. Tibial Spine Avulsion Fracture Physical Therapy Protocol Prescription Patient Name: Date: DOI: Surgery Date: Diagnosis: Tibial Spine Avulsion Fracture Frequency: 2-3 visits/week Before Background: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Webfracture into the tibial plateau.18,23,27,35 Treatment is based on these characteristics and tailored to each fracture pattern. Immediate Postoperative/Max Protection Phase (Weeks 1-4) Goals: Restore full passive knee extension Diminish pain and joint swelling Restore J Orthop Surg (Hong Kong). Physeal injuries in children's and youth sports: reasons for concern? doi: 10.2106/JBJS.RVW.19.00186. Exercises to strengthen the quadriceps muscles, Activity modification - avoiding excess pivoting sports. Please enable it to take advantage of the complete set of features! Recommend a few days without weight-bearing activity until swelling resolves, followed by weight-bearing activity as tolerated. The mean postoperative AKPS and KOOS5 scores were 72.98 21.51 and 75.05 16.02, respectively. WebPalpation: Palpation of the tibia is critical for differential diagnosis. Cole WW 3rd, Brown SM, Vopat B, Heard WMR, Mulcahey MK. AOSSM checks author disclosures against the Open Payments Database (OPD). A Systematic Review of 21 Tibial Tubercle Osteotomy Studies and More than 1000 Knees: Indications, Clinical Outcomes, Complications, and Reoperations. Type A Fractures below the tibial plafond and typically transverse. Weeks 6 to 8: Full weight bearing. AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Background: Clipboard, Search History, and several other advanced features are temporarily unavailable. HHS Vulnerability Disclosure, Help Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with 6 months of follow-up. Rehabilitation Protocol After Tibial Tubercle tibial fractures6,7,20,21,42,47 because patients reach a higher degree of activity and confidence sooner with a vulnerable tibia in the Conclusion: Loss of motion, especially loss of extension can be quite problematic during the rehabilitation process, as it is associated with greater functional deficits during weight-bearing activities . Focal or local tenderness at the posteriormedial margin of the tibia near the middle and distal thirds of the bone are a sign of tibial stress fracture. care applies to the rehabilitation of patients following a tibial tubercle osteotomy (TTO) at Brigham and Womens Hospital (BWH). 2018;10(5):441452. doi: 10.1615/JLongTermEffMedImplants.2020035921. 2010; 29: 303-311. sharing sensitive information, make sure youre on a federal 2020 Oct;158(5):466-474. doi: 10.1055/a-0979-2384. Intercondylar eminence fracture treated by resorbable magnesium screws osteosynthesis: A case series. Proximal re-alignment is often done in combination with a distal re-alignment procedure. The piece of bone is reattached to the tibia using two screws. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Open reduction and cannulated screw osteosynthesis was done. FOIA JBJS Rev. Web900 Round Valley Drive, Suite 100 / Park City, UT 84060 / Telephone (435)655-6600 / Fax (435)655-2388 Tibial Plateau Fracture Post-Operative Protocol Results: The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Sports Health. official website and that any information you provide is encrypted government site. Remove for rehab ACL+PCL. To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO. WebThe surgeon then uses a bone-cutting instrument to cut the tibial tubercle (to which the patellar tendon attaches) so that the bone and patellar tendon can be moved medially or toward the inside of the knee. Orthopedic management of tibial plateau fractures varies from conservative non-operative treatment to open reduction and internal fixation (ORIF). Federal government websites often end in .gov or .mil. doi: 10.1016/j.injury.2018.09.055. 10.1615/JLongTermEffMedImplants.2020035921. The surgeon then uses a bone-cutting instrument to cut the tibial tubercle (to which the patellar tendon attaches) so that the bone and patellar tendon can be moved medially or toward the inside of the knee. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Enter the email address you signed up with and we'll email you a reset link. You can download the paper by clicking the button above. 8600 Rockville Pike CPT, Current Procedure Terminology; TTO, tibial, General accelerated postoperative rehabilitation program. In addition to these fundamental aspects of the physical examination, many special provocation or relief tests and signs have been developed. Evidence of tibial tubercle osteotomy integration. BMC Musculoskelet Disord. 2020 Apr;8(4):e0186. If the Q-angle is greater than 15 degrees, there may be a tendency of the patella to track or move laterally (toward the outside of the knee). Before For displaced (type II/III) fractures, surgical treatment has included fixation with screws, sutures, or wires performed through either open or arthroscopic approaches. This procedure re-aligns the pull of the quadriceps muscles across the knee by decreasing the Q-angle. Tibial Plateau Fracture Rehab Protocol Keys to a Successful Outcome Early passive joint motion is key. Inclusion criteria were tibial tubercle fractures in children younger than 18 years. WebACI OF PATELLA. a. Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. Physiotherapy and rehabilitation during the acute postoperative phase is mainly oriented to minimizing impairment. Sorry, preview is currently unavailable. 17. The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia. b. Operative treatment for patellofemoral instability consists of surgery to re-align the patella and to decrease the Q-angle. sharing sensitive information, make sure youre on a federal 2020;9(11):e1731e1736. No knee motion was possible because of pain. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. Clinical sports medicine. The .gov means its official. official website and that any information you provide is encrypted The two screws can be removed when the bone is completely healed (after about six months) if they are tender. -, Chen H, Zhao D, Xie J, et al. A thorough physical examination begins with a detailed history followed by inspection, palpation, and testing of muscle strength, tone, reflexes, and sensation. Bookshelf HHS Vulnerability Disclosure, Help and transmitted securely. TREATMENT GOALS: ROM: full Normal gait and reciprocal stair management without compensation, assistive devices as needed. Open brace to 45- 60 of flexion week 6, 90 at week 7. REHABILITATION GUIDELINES FOR TIBIAL PLATEAU FRACTURE 3 | P a g e (Phase III continued) Rehabilitation Goals Full ROM knee flexion and extension Strength 80% of The https:// ensures that you are connecting to the This article presents a 14-year-old boy with an Ogden type IIIB tibial tubercle avulsion fracture that was misdiagnosed on radiographs at presentation as type IB. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. They often occur in male adolescent athletes, usually in relation with sports involving powerful jumps. Bookshelf This case emphasizes that minimally invasive techniques may sometimes be inappropriate in the management of these types of fractures. Classically, rehabilitation protocols after TTO procedures have included brief hospitalizations, extended nonweightbearing status, bracing the involved knee in extension, and limiting early weightbearing with assistive devices (ie, crutches) for a period of 6 to 8 weeks to reduce the risk of fixature failure or tibial fracture. He had a positive history of acute postoperative phase is mainly oriented to minimiz- Osgood-Schlatter disease. Tibial Tubercle Fracture Download Protocol as a PDF Phase I (Weeks 0 4) TDWB with crutches and immobilizer/brace locked in extension NO RANGE OF MOTION FOR FIRST 4 WEEKS Strengthening: Sub maximal quadricep sets, glut sets, HS sets Ankle pumps Patellar Thus, an accurate diagnosis and well-organized treatment plan are critical. 2019;27(3):2309499019861145. 3. lower-limb injuries in endurance sports, Orthoses in the Prevention and Rehabilitation of Injuries, Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement, Hip and Pelvis Injuries in Special Populations, Predicting Sagittal Plane Landing Kinematics with Lower Extremity Muscular Power Tests, Epidemiology of injuries in high-level youth sport in Luxembourg [Abstract], Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine, Tibialis Posterior Tendon and Deltoid and Spring Ligament Injuries in the Elite Athlete, Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete, Paediatric.Musculoskeletal.Disease.3HAXAP, Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Avulsion of the tibial tuberosity in adolescent is rare , and is usually produced by sudden violent contraction of the quadriceps muscles . WebGREATER TUBEROSITY AVULSION FRACTURES Please note: This document is intended to provide guidelines for the postoperative rehabilitation of a patient who have suffered a nonoperative fracture of the proximal humerus, or greater tuberosity avulsion fracture. The https:// ensures that you are connecting to the This article presents a 14-year-old boy with an Ogden type IIIB tibial tubercle avulsion fracture that was misdiagnosed on radiographs at presentation as type IB. ACL Injuries - Non-operative Management; ACL Reconstruction; High Tibial Osteotomy Protocol; Iliotibial Band Syndrome; Knee Joint Resurfacing; MCL Injury; Medial Patellofemoral Ligament (MPFL) Reconstruction Ankle Fracture with Open Reduction and Internal Fixation (ORIF) The patella protects the knee from a direct blow and, more importantly. When the quadriceps muscles contract, the knee straightens (extends). If the patella partially dislocates (subluxates) the knee will give-way or buckle. There is no study in the literature covering arehabilitation program after avulsion fracture following Osgood-Schlatter disease. Open reduction and cannulated screw osteosynthesis was done. CONSORT (Consolidated Standards of Reporting Trials) flowchart. MeSH Surgical treatment can be divided into two basic types: Proximal re-alignment consists of making a small incision at the knee and lengthening the restraining structures on the outside of the patella and/or shortening the ligaments on the inside of the patella. Methods: Federal government websites often end in .gov or .mil. *COLE,*MD,*MBA WEIGHT BEARING BRACE** ROM EXERCISES PHASE I 0-2 weeks Full in Brace locked in extension* Locked in full extension for sleeping and all activity* Off for exercises and hygiene 0-90 when Fractures of the anterior tibial tubercle are infrequent lesions. Tibial tubercle avulsion fractures are uncommon injuries that are seen mostly in adolescent male patients during athletic activities. Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature. Type B Fractures at level of tibial plafond and typically extend proximally in a spiral or short oblique fashion. Rehabilitation after anteromedialization of the tibial tuberosity. WebFractures of the anterior tibial tubercle are infrequent lesions. Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). PMC Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called "sports hernia." There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. Purpose: Functions, disabilities and perceived health in the first year after total knee arthroplasty; a prospective cohort study. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics. Promote healing of realignment tibial tuberosity Quadriceps Strengthening Brace: Continue brace for ambulation only Discontinue brace (week 4) Weight Bearing: Progress WBAT (2 In general, tibial plateau fracture rehab protocols span three stages: Non-Weight Bearing Week 0 - 1: Protection Against Complications Hold the knee up above your [Fractures of the tibial tuberosity associated with avulsion of the patellar ligament in adolescents]. The outcome was excellent after a 12-week rehabilitation protocol. Please enable it to take advantage of the complete set of features! Fully resolve knee swelling. This procedure is usually used in young patients in whom the growth plates are still open. Epub 2015 Jan 16. Academia.edu no longer supports Internet Explorer. Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. Tibial spine fractures are characterized by fractures at the insertion site of the anterior cruciate ligament (ACL) on the tibia and were first classified into 3 types. The tibiofemoral joint is formed by the thigh bone (femur) meeting the shin bone (tibia). Bethesda, MD 20894, Web Policies BMC Musculoskelet Disord. The surgical indication was primarily for patients with recurrent patellar instability. Clipboard, Search History, and several other advanced features are temporarily unavailable. The site is secure. An official website of the United States government. WebTIBIAL TUBERCLE EXCISION (OSGOODE-SCHLATTER) REHABILITATION PROTOCOL ! This is a relatively minor procedure. 2015 Apr;46(4):767-9. doi: 10.1016/j.injury.2015.01.012. You may bear partial weight on the leg when using the immobilizer and crutches when you are comfortable doing so. Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols. If your knee feels better when you extend your knee while the tibia is held internally rotated (decreasing the Q-angle) and feels worse when you extend your knee while tibia is held in external rotation (increasing the Q-angle), then you may have lateral patellar instability. PMC Would you like email updates of new search results? 2018 Nov;49 Suppl 3:S48-S53. Tibial Tuberosity Osteotomy Rehabilitation Protocol Description of Procedure: Tibial tuberosity osteotomy (TTO) involves a cut of the tibial tuberosity, effecting centralization of patellar Tibial tubercle fracture- For un-displaced fractures, immobilize the knee. Injury. AMZ (ANTEROMEDIALIZATION / TIBIAL TUBERCLE COPYRIGHT*2014*CRC*BRIAN*J. Background: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Webof periosteum impinged in both fracture gaps. Pain in the front of the knee and a sensation of looseness of the kneecap are common complaints. Tibial Tubercle Osteotomy (Distal Realignment) Post-Operative Rehabilitation Protocol Microsoft Word - Tibial Tubercle Osteotomy Rehabilitation Protocol.doc Author: Eric Strauss Fractures of the proximal tibial epiphysis in adolescents are uncommon, and generally result from severe direct or indirect force around the knee . WebExplore Our Sports Physical Therapy Rehabilitation Protocols. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. One or more of the authors has declared the following potential conflict of interest or source of funding: C.M.E. The mechanism of injury usually involves a strong eccentric contraction of the quadriceps femoris muscle when the proximal tibial physis is closing, leading to failure of the physis at the patellar tendon insertion. Rehabilitation Protocol: Tibial Spine Open Reduction Internal Fixation Name: _____ Date: _____ Diagnosis: _____ Date of Surgery: _____ Phase I (Weeks 0-4) The treatment for patellofemoral instability can be either non-operative or operative. Displaced tibial eminence fractures disrupt the continuity of the femur-ACL-tibial viscoelastic chain and can cause mechanical block to knee extension. Disclaimer, National Library of Medicine ing TIBIAL TUBERCLE OSTEOTOMY PHASE I: ~0-2 Weeks Postoperative GOALS: WBAT with crutches/brace Monitor wound healing Full extension DRESSING: POD 1: Debulk Saltzman BM, Rao A, Erickson BJ et al. 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Progression of Disclaimer, National Library of Medicine To browse Academia.edu and the wider internet faster and more securely, please take a few seconds toupgrade your browser. The clinician then forms an impression from the information gathered during the history and physical examination and may use more advanced diagnostic tests to rule in or rule out a diagnosis. 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