(Medial Opening Wedge – Locking Plate Fixation)
Based on Althoff & Gomoll 2026 + European consensus

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PHASE 0 — Immediate Post-Op (Day 0–2)

Goals

• Protect osteotomy
• Minimize pain & swelling
• Prevent stiffness (critical — avoids patella baja & fat pad fibrosis)
  

Key Actions

• Ice, compression, elevation
• Immediate active/assisted ROM:
  • 0–90° flexion permitted unless combined procedures dictate otherwise
• Quadriceps activation (QS, SLR with brace locked)
• Ankle pumps

Weight Bearing

• Toe-touch or 20 kg partial WB with crutches (typical for OW-HTO)
• May modify depending on fixation stability + graft usage

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PHASE 1 — Early Mobility (Week 0–2)

Goals

• Achieve 0–110° ROM
• Maintain full passive extension
• Control swelling & quadriceps inhibition

Exercises

• Heel slides
• Continuous passive motion (if used)
• Stationary bike with low resistance (once ≥100° flexion)
• Patellar mobilization
• QS, SLR, hip abduction/adduction

Weight Bearing

• Continue partial WB
• Progress if radiographs show good stability

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PHASE 2 — Progressive Loading (Weeks 3–6)

Goals

• Full ROM (slope protection requires controlled flexion early)
• Gradual return to functional weight bearing
• Normalize gait

Exercises

• Leg press (0–60°)
• Mini-squats (0–45°)
• Closed-chain hip/glute strengthening
• Core stabilization
• Aquatic therapy (once incisions healed)

Weight Bearing

• Increase to 50–75% WB by week 4–5
• Full WB typically at 6 weeks, depending on union progression
  • Larger corrections or allografts may delay to 8–10 weeks
  • Consistent with nonunion-risk guidance (large gaps >10 mm)

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PHASE 3 — Strength & Neuromuscular Control (Weeks 6–12)

Goals

• Full WB pain-free
• Begin endurance & strength training
• Restore balance and proprioception

Exercises

• Step-ups/downs
• Single-leg stance / wobble board
• Leg press 0–90°
• Hamstring curls (avoid excessive shear early if slope modified)
• Cycling with moderate resistance
• Elliptical trainer

Criteria to Progress

• Pain-free full WB
• Radiographic evidence of early union
• ROM nearly symmetric with contralateral side

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PHASE 4 — Advanced Strengthening (3–4 months)

Goals

• Restore ≥80% limb symmetry in strength
• Prepare for sport-specific progression

Exercises

• Lunges (multiplanar)
• Squats to 90°
• Light plyometrics (double-leg only at first)
• Leg press full range
• Hip/glute strengthening progression

Restrictions

• Avoid deep flexion torque >90° until full radiographic union

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PHASE 5 — Return to Impact & Sport (4–6+ months)

Goals

• Return to recreational sport
• Restore functional power and neuromuscular control

Exercises

• Jogging progression (treadmill → outdoor)
• Single-leg plyometrics
• Agility training
• Sport-specific drills

Return to Sport

• Low-impact sports: 4–6 months
• Pivoting / high-impact sports: 6–9+ months (depending on union & alignment)

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Radiographic Follow-Up

• 2 weeks: wound, early alignment
• 6 weeks: progression to full WB
• 3 months: union assessment
• 6 months: confirm full union
• Hardware removal possible after ≥1 year if symptomatic (common)

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Union Optimization / Complication Prevention

• Correct vitamin D deficiency pre-op (nonunion risk reduction)
• Larger corrections >10 mm → consider grafting & slower WB progression
• Avoid prolonged immobilization (prevents patella baja)
• Monitor hinge stability — if fractured, delay WB per fixation strategy