Weight-Bearing After Open Patellar Tendon Repair
Patients can begin weight-bearing as tolerated immediately postoperatively with a knee brace locked in extension (0°), with gradual progression to 30° flexion over the first 2 weeks.
Immediate Postoperative Protocol
The evidence supports early mobilization after patellar tendon repair without compromising healing or increasing complication rates. Based on the available research:
- Full weight-bearing as tolerated is permitted from day 0-1 postoperatively 1, 2, 3
- The knee brace should be locked in full extension initially for the first 1-2 weeks 1, 2
- This approach allows patients to ambulate safely while protecting the repair during early healing
Rationale for Early Weight-Bearing
Multiple studies demonstrate that immediate weight-bearing with appropriate bracing does not increase rerupture rates and may actually improve outcomes 3. One study specifically showed that patients allowed full weight-bearing as tolerated postoperatively achieved excellent functional results without any reruptures 3. The key protective element is the locked extension brace, not weight-bearing restriction itself.
Progressive Range of Motion Protocol
While maintaining weight-bearing as tolerated throughout, the brace settings should progress as follows:
- Weeks 1-2: Brace locked at 0° (full extension) during ambulation; passive flexion to 30° allowed during therapy sessions 4, 2
- Weeks 3-4: Progress to 60° flexion 4
- Weeks 5-6: Advance to 90° flexion 4, 1
- Week 7 onward: Free active range of motion and unrestricted weight-bearing 2
Critical Considerations
The distinction between weight-bearing and range of motion is essential: Weight-bearing as tolerated can begin immediately, but the knee must remain in a protected position (locked extension brace) during ambulation for the first 2 weeks. This protects the repair from excessive tensile forces while allowing functional mobility.
Avoid the common pitfall of confusing weight-bearing restrictions with motion restrictions. The repair is vulnerable to tensile loading from active knee extension and excessive flexion angles, not from axial loading through the leg during protected weight-bearing 3.
Some older protocols recommended 6 weeks of non-weight-bearing 5, but more recent evidence with augmented repair techniques supports immediate mobilization without increased complications 2, 3. The use of internal bracing or cable augmentation techniques has made early weight-bearing protocols safer and more predictable 2, 3.