Rehabilitation Protocols
Conservative and postoperative pathways, organised by phase. Guidance for families, progression criteria for physiotherapists and illustrated exercises to select for the visit handout.
A handout for the visit
Open the relevant sheet, choose the phase where applicable, then print.
These documents are protocol templates for information and education only: they do not replace the rehabilitation prescription for the individual case. Timing, loading and progressions must always be adapted to the patient, the lesion pattern, the surgical technique used and the clinical course, in collaboration between orthopaedic surgeon, physiotherapist and, where appropriate, physiatrist. Progression is driven by objective criteria, not by the calendar alone.
Knee
Pathways for ligaments, meniscus, osteochondral lesions and guided growth, distinguishing conservative care from recovery after surgery.
Anterior Cruciate Ligament (ACL) Reconstruction
Five-phase pathway after ACL reconstruction in the skeletally mature patient: from early post-operative recovery to return to team, with objective criteria between phases.
Return to pivoting sport: not before 9 months, typically 9-12 monthsPaediatric ACL reconstruction (all-epiphyseal / all-inside)
Protocol for the patient with open growth plates operated with physeal-sparing techniques: more cautious progressions, growth surveillance and later return to sport.
Pivoting sport generally no earlier than 12 months in younger athletes; individualise criteria and growth surveillance.ACL reconstruction with meniscal repair
Combined protocol: on top of the ACL progression sit the loading, deep-flexion and rotation restrictions required for healing of the repaired meniscus.
The pathway respects both repairs; pivoting sport resumes only after the ACL timing and criteria are met.Isolated meniscal repair
A meniscal repair pathway tailored to stable vertical, radial, root or complex tears. Weight bearing, ROM and return to sport require instructions specific to the repair performed.
Recovery depends on repair type and criteria; at least 4 months for vertical tears, often 6-9 months for radial, root or complex tears.MPFL reconstruction after patellar dislocation
Pathway after medial patellofemoral ligament reconstruction: early graft protection, recovery of quadriceps control and dynamic valgus control, return to sport without apprehension.
Return to sport: typically 6-9 monthsKnee OCD: conservative rehabilitation
Protection and functional recovery for stable juvenile knee osteochondritis dissecans, after orthopaedic assessment. Activity, loading and return also depend on the lesion’s course on imaging.
A pathway over months: scheduled reviews; progression according to stability, healing and functionKnee Osteochondral Lesion: fragment fixation or microfracture
Six-phase pathway after treatment of an osteochondral lesion of the femoral condyle or patella, detailing the substantial differences between fragment fixation (native hyaline cartilage is preserved) and microfracture (reparative fibrocartilage is formed).
Protected weight bearing 6-8 weeks · Running 4-6 months · Contact/pivoting sport 9-12 months (fixation) or 8-12 months (microfracture)Tibial Spine (Eminence) Fracture: reduction and fixation with bioabsorbable pins
Five-phase protocol after reduction and fixation of a tibial eminence fracture with bioabsorbable pins (Smart Nails), screws or suture: the paediatric equivalent of an ACL injury, except that here bone heals, not ligament.
Immobilisation in extension 30 days · Non-weight bearing 30 days · Full weight bearing 6-8 weeks · Running 3-4 months · Pivoting sport 6-9 monthsHemiepiphysiodesis: recovery after guided growth
Recovery of movement, walking and activity after isolated hemiepiphysiodesis around the knee. Growth follow-up continues even when the child feels well again.
Functional recovery over the first weeks; alignment correction and follow-up over timeAnkle
Uncomplicated lateral sprain and talar osteochondral lesions: separate conservative and postoperative pathways.
Ankle sprain: conservative protocol
Conservative pathway based on early protected loading, peroneal strengthening and proprioceptive retraining, with objective return-to-sport criteria and prevention of chronic instability.
Uncomplicated lateral ankle sprain: recovery over weeks, with timing and return guided by assessmentTalar OCD: conservative rehabilitation
A pathway for a stable juvenile osteochondral lesion of the talus treated without surgery: protection, authorised loading recovery, motion and graded return to activity.
Initial protection and recovery over months; timing determined through follow-upOsteochondral Lesion of the Talus: fragment fixation or microfracture
A protected five-phase pathway after osteochondral fragment fixation or talar dome microfracture. Loading, motion and sport depend on the procedure performed and the surgeon’s assessment.
Indicative windows: protection in the first weeks · authorised loading recovery · running and sport in the following monthsFoot
Recovery after flatfoot surgery, with loading and motion adapted to the procedure and associated operations.
Flatfoot: post-operative pathway after endosinotarsal arthroereisis
Pathway after endosinotarsal arthroereisis without a cast: protected weight bearing and early movement within discharge instructions, with progression guided by recovery and clinical review.
Early motion if authorised · Protected weight bearing with crutches · Strengthening after recovery and clearance · Running and sport based on criteria and reviewFlatfoot: post-operative pathway after exosinotarsal arthroereisis
Pathway after exosinotarsal arthroereisis without a cast: protected weight bearing and early movement within discharge instructions, with progression guided by recovery and clinical review.
Early motion if authorised · Protected weight bearing with crutches · Strengthening after recovery and clearance · Running and sport based on criteria and reviewFlatfoot: post-operative pathway after arthroereisis with Achilles lengthening
Pathway after arthroereisis with Achilles tendon lengthening: a below-knee cast for about 30 days as prescribed, followed by gradual recovery of movement and strength within authorised limits.
Cast for the prescribed period · Motion after removal and clearance · Strengthening after recovery and clearance · Running and sport based on criteria and reviewFlatfoot: post-operative pathway after arthroereisis with accessory navicular excision
Pathway after arthroereisis with simple accessory navicular excision, without tibialis posterior repair: a cast for about 15 days as prescribed, followed by permitted gradual movement and scar care.
Cast for the prescribed period · Motion after removal and clearance · Strengthening after recovery and clearance · Running and sport based on criteria and review
Any questions?
For information or questions, email me or view the locations and contact details.
Email: daniele.priano@ortopediaevolutiva.com