Phase I: Protection and Early Recovery (0–6 Weeks)

Immobilisation:

• Zimmer knee splint in extension for 6 weeks

• Splint removed for hygiene and prescribed exercises only

Precautions:

• Weight bear as tolerated with the knee locked in extension

• No active knee extension against resistance

• Avoid loaded knee flexion

• Avoid kneeling and impact activities

Therapy:

• Oedema management and elevation

• Gait retraining with walking aids as required

• Static quadriceps activation

• Active and passive knee range of motion as permitted

• Active ankle and hip range of motion

Criteria to Progress:

• Wound healed

• Pain controlled

• Minimal swelling

• Independent mobilisation

• Good quadriceps activation

Phase II: Restore Motion and Progressive Loading (6–12 Weeks)

Immobilisation:

• Wean Zimmer knee splint

Precautions:

• Continue weight bearing as tolerated

• Avoid resisted knee extension initially

• Avoid deep loaded knee flexion

• Avoid impact activities

Therapy:

• Progress knee range of motion

• Continue quadriceps strengthening

• Commence closed-chain strengthening

• Patella mobilisation and gait retraining

Criteria to Progress:

• Functional knee ROM

• Minimal swelling

• Improving quadriceps strength

• Independent gait

Phase III: Strength and Functional Recovery (12–16 Weeks)

Precautions:

• Gradually increase loading following evidence of fracture healing

• Avoid repetitive loaded knee flexion initially

• Avoid high-impact activities

Therapy:

• Progressive strengthening

• Functional lower limb rehabilitation

• Balance and proprioception exercises

• Endurance exercises

Criteria to Progress:

• Clinical and radiographic progression toward union

• Functional ROM restored

• Improved quadriceps strength

• Normalising gait pattern

Phase IV: Return to Function and Endurance (4–6 Months)

Precautions:

• Gradual return to unrestricted activity

• Avoid abrupt progression into impact loading

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation

Criteria to Progress:

• Radiographic union achieved

• Functional strength restored

• Full extension with functional flexion

• Return to unrestricted activity

General Recommendations

Work:

• Office and sedentary work may resume after approximately 2–4 weeks depending on comfort

• Manual labour is commonly delayed until approximately 3–6 months depending on fracture healing and occupational demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Upper-limb exercise and non-impact activities may resume as comfort allows.

• Progressive return to gym and functional lower limb activities from approximately 8–12 weeks.

• Running, jumping, kneeling, pivoting, and impact activities are typically introduced from approximately 3–6 months or longer with full recovery and surgeon clearance.

Thromboprophylaxis

A combination of mechanical and pharmacological thromboprophylaxis is generally recommended following lower limb orthopaedic surgery. The selection of the specific agent (e.g., aspirin, low molecular weight heparin, or a direct oral anticoagulant) and the duration of prophylaxis will be discussed and determined in consultation with A/Prof Ernstbrunner and his medical team, based on the individual patient's risk profile and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.