Tibial Plateau Fracture

One Patients Story to Treatment and Recovery

““After falling and fracturing my leg, I was only able to bear 50 pounds of weight through my leg. I was scared at first, but it was amazing; I felt like I was floating on air. I couldn’t believe I was walking and not in pain. The AlterG is definitely helping me reach my rehabilitation goals. Next week, I can start to bear more weight and the AlterG will really help me add weight slowly and safely as I continue to regain strength. I can see myself walking the way I used to.””

Sandra Jaquis, Patient, Southlake Village Rehabilitation and Care Center

One Patients Tibial Plateau Fracture Rehabilitation

J.C.A. Noorduyn, Msc


An 41 year old female was diagnosed with a fractured left lateral tibial plateau after an high impact moment during horseback riding. The high impact moment occured with a fully extended leg when trying to step off as the horse was reared up. After a visit to the emergency room, the patient was sent home with a cast for two weeks before surgery was performed. Thereafter, the fracture was internally fixated with osteosynthetic material and the patient was referred to physiotherapy directly after surgery. A non-weight bearing policy was applied for the first 6 weeks post-surgery, thereafter weight bearing could be increased guided by the pain.

To download this Case Study click here. 


The treatment goals set by the patient and therapist were as follows:


Main goals:
  • Return to normal daily activities
  • Return to sport activities (horseback riding)

  • Subgoals:
  • Full weight bearing at 12 weeks post-surgery.
  • Restore normal range of motion (ROM)
  • Restore normal gait pattern
  • Restore normal strength
  • Restore cardiovascular condition
  • History / Progression

    Initially, the patient showed loss of range of motion (ROM) of flexion and extension of the knee (90/5/0), extra- and intra-articular edema and muscle atrophy of the left lower extremity. During the non-weight bearing phase, the physical therapy treatment consisted mobilizing exercises, non-weight bearing strengthening exercises and soft tissue mobilization. After 3 weeks full ROM (140/0/5) had been restored and edema was reduced.  

    At 4 weeks post-surgery treatment focused on dynamic mobilizing exercises such as cycling, and increasing muscle strength using the Biodex system pro 4 isokinetic dynamometer (Biodex Medical Systems, Inc., Shirley, New York, USA) for quadriceps and hamstring strength.

    At 6 weeks post-surgery, weight bearing gait training was started at 20% of body weight using the AlterG Anti-Gravity Treadmill® walking forward at 2.5 km/u for 10 minutes. The gait training progressed over the next 5 weeks increasing the weight, speed and duration up to 100% at 5 km/u for 30 minutes (see progression table).

    Besides gait training a progressive exercise program was performed consisting of strength training, stabilization exercises and coordination exercises. After each exercise session the involved knee was treated with a cooling and compression system (Game Ready®) to enhance soft tissue recovery.

    To see the progression table, please click here. 

    Objective Data

    Three measurements were conducted at onset of the AlterG progressive weight bearing program, 6 weeks post-surgery (Baseline). The measurements were repeated at 9 weeks post-surgery (T1) and at 12 weeks post-surgery (T2).

  • Range Of Motion (ROM)
  • Knee injury and Osteoarthritis Outcome Score (KOOS)
  • Patient Specific Complaint questionnaire (PSK); Dutch questionnaire to determine the effort of specific tasks. Consisting of three items:
  • PSK 1: lying in bed
  • PSK 2: working
  • PSK 3: standing for a long period
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