Post-Tenotomy Protocol

Phase 1: 0-2 Weeks

  • Special Considerations:
    • Early NWB pain free ROM encouraged starting day after procedure
  • Restrictions:
    • Patellar Tendon:
      • Week 1 0-30°
      • Week 2 0-60°
    • PWB on crutches x 7 days (knee/hip)
    • WBAT in walking boot x 7 days (foot/ankle)
    • May d/c crutches/boot when able to walk pain free without a limp
    • Do not walk barefoot (foot/ankle)
  • Goals
    • Control swelling
    • Restore ROM
    • Muscle activation
  • Functional test to progress to the next phase:
    • Normal/symmetric gait pattern (no assistive device)
    • Pain free passive ROM (ankle dorsiflexion/knee and hip flexion)

Phase 2: 2-6 Weeks

  • Special Considerations:
    • Pain < 3/10 with all activities
  • Restrictions:
    • Patellar Tendon:
      • Week 3 0-90°
    • No running, jumping, cutting, pivoting
  • Goals
    • Neuromuscular control
    • Proprioception
    • Gentle muscular strengthening
  • Functional test to progress to the next phase:
    • Foot/Ankle: at least 1 unilateral SL heel raise through full ROM
    • Knee/Hip: Single leg squat through partial ROM

Phase 3: 6-12 Weeks

  • Special Considerations:
    • None
  • Restrictions:
    • Monitor load progression (as discussed at the end of the protocol)
  • Goals
    • Progressive strengthening
    • Sport/region specific RTP preparation
  • Functional test to progress to the next phase:
    • Lunge walk x 10 steps
    • Pain free jogging prior to formal return to run progression
    • 10 single leg hops

Phase 4: 12+ Weeks

  • Special Considerations:
    • Not applicable for all patients
  • Restrictions:
    • Monitor load progression (as discussed at the end of the protocol)
  • Goals
    • Full unrestricted return to sport/work
    • Transition to maintenance program (S&C, personal trainer, self-directed HEP)
  • Functional test to progress to the next phase:
    • Specific to demands of sport/position
    • Guided by AT and S&C staff

 

  • To be used as a general guide based on biologic tissue healing. This timeline does not consider the location and extent of diseased tissue as well as other intrinsic patient factors that may impact time to clinical healing.
  • Basic load progression principles: Pain level < 3/10 with activity. Any pain associated with the activity should not persist into the following day. If pain persists then the load needs to be decreased