EFFECT OF EARLY WEIGHT BEARING AND ACTIVE KNEE EXERCISES IN TREATMENT OF TIBIAL PLATEAU FRACTURES

November 19, 2025 updated by: mohmed yehia elabd hasan, Cairo University

COMBINED EFFECT OF EARLY WEIGHT BEARING AND ACTIVE KNEE EXERCISES IN TREATMENT OF TIBIAL PLATEAU FRACTURES WITH INTERNAL FIXATION

This study will answer the following research questions:

Are there any significant differences between combination of early active knee ROM exercises and weight bearing versus early passive ROM with delayed weight bearing on pain intensity, ROM knee flexion and extension, function, and radiological healing in treatment of patients with TPFs fixed with plates and screws?

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

This study will be conducted to compare the effects of combining early active knee ROM exercises and weight bearing versus early passive ROM and delayed weight bearing on pain intensity, ROM knee flexion and extension, function, and radiological healing in treatment of patients with TPFs fixed with plates and screws.

Tibial plateau fractures are associated with unfavorable outcomes due to a variety of factors, including soft tissue envelopes and cartilage damage, comorbidities such as compartment syndrome, postoperative infection, stiffness or malfunction of the knee, and even post-traumatic osteoarthritis (Narang et al., 2021). Consequently, they not only present surgical challenges but also have serious negative effects on function and quality of life (Arnold et al., 2017; Bhamra and Naqvi, 2021).

Physical therapy including active exercises is well supported in literature but in the late phases of rehabilitation. The concept of introducing early active exercises to patients undergoing rehabilitation following TPFs repaired with implants isn't well-supported in the literature. There aren't any comprehensive studies that specifically examine the application of early active exercises for TPFs repaired with plates and screws (Phansopkar et al., 2022).

There are few studies in form of case reports that applied early active exercises for patients with TPFs. It was found that appropriate surgical intervention followed with planned exercise protocol focussing on long term benefits can greatly help patients with TPFs to achieve early pain free mobility in lower limbs (Narang et al., 2021; Arya and Harjpal, 2023; Bhure et al., 2022).

this study will assess the long term effects of the treatment program for patients with TPFs fixed with plates and screws. So this study will be conducted, using valid and reliable methods and instrumentations, to determine if there are any effects of combined effect of early active 6 exercises and early weight bearing in treatment of patients with TPFs fixed with plates and screws which will add a new step in the pyramid of evidence for the best treatment methods for patients with TPFs fixed with plates and screws.

Study Type

Interventional

Enrollment (Estimated)

28

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
    • Giza Governorate
      • Giza, Giza Governorate, Egypt
        • faculty of physical therapy cairo university, Giza,

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Inclusion Criteria Participants will be included in the study if they had TPF type II Schatzker fixed with plate and screws. Their aged range from 18-50 years old while their BMI range from 18.5 to 29.9 kg/m2 (Mohamed et 25 al., 2019; Hoseini et al., 2022; Phansopkar et al., 2022). They are referred from an orthopedic surgeon immediately after the operation.

Exclusion Criteria Participants will be excluded from this study if they didn't fulfil the inclusion criteria or if they had one of the following. Other types of TPFs or methods of fixation, previous hip or lower extremity injury or surgery e.g. arthroplasty, systemic diseases e.g. diabetes, rheumatoid arthritis, pathological conditions of the lower extremities e.g. tumours, infections, leg deformity, cardiovascular disease such as hypertension, and neurological diseases.

Exclusion Criteria:

-

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group A will receive early active knee ROM exercises with weight 24 bearing.

Group A

Early active exercises will be applied from the first day by the participation of the patient with the assistance of the physiotherapist as follows:

Weeks: 1-4

The program will be applied according to (Mohamed et al., 2022) as follows:

Week: 1

Day: 1-2:

  1. Static quadriceps, hamstrings and glutei.
  2. Static abdominal and back exercises.
  3. Active knee flexion and extension ROM exercises as possible according to patient tolerance and pain.

Day: 3-4:

In addition to the previous we add the following

  1. Ankle toe movement.
  2. Active exercises of the unaffected limb.
  3. Respiratory exercises. 33
  4. Cryotherapy.
  5. Active assisted hip abduction (0° -10°).
  6. Ankle toe movement; heel slides (0°-5°). Day: 5-7

In addition to previous exercises, the following exercises will be added:

  1. Half bridging exercise.
  2. Active SLR (0°-15°).
  3. Active abduction (0°-15°).
  4. Active adduction (15°-0°).
  5. Heel slides (0°-10°). Weight bering excecises Ten percent of load on the affect leg
Other: Early active exercises will be applied from the first day by the participation of the patient with the assistance of the physiotherapist
The difference between each group is in the first four weeks and the type of program group one started with active exercise from the first day 38 group 2 active exercises started from week five at the first four weeks program is done by passive ROM modalities and by the physiotherapist. Early weight bearing is early in group 1 from the first week and late in group 2 after four weeks
Active Comparator: Group B will receive early passive ROM with delayed weight bearing.

Passive ROM will be applied from the first day according to (Arslan, A et al., 2015) and late weight bearing based on (Amin et al.,2023) as follows:

Weeks: 1-4

  1. Cryotherapy for 10 minutes three times per day.

  2. Passive exercises:

    1. ROM exercises.
    2. Passive ankle toe movements for 10 repetitions.
    3. Passive knee flexion as tolerated The program will be applied without active participation from the patient. It will be applied by the physiotherapist.
  3. Weight bearing is mainly in the sound side not affected so no weight bearing in the affected limb for about four weeks (Amin et al., 2023).

Weeks: 5-8 Same protocol as Group A. Weeks: 9-12 Same protocol as Group A. Weeks: 13-16 Same protocol as Group A. The difference between each group is in the first four weeks and the type of program group one started with active exercise from the first day 38 group 2 active exercises started from week five at the first four weeks program is done by passive ROM modalities and by the physiotherapis
Other: Early active exercises will be applied from the first day by the participation of the patient with the assistance of the physiotherapist
The difference between each group is in the first four weeks and the type of program group one started with active exercise from the first day 38 group 2 active exercises started from week five at the first four weeks program is done by passive ROM modalities and by the physiotherapist. Early weight bearing is early in group 1 from the first week and late in group 2 after four weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Numerical Pain Rating Scale
Time Frame: 5 min
This scale will be used to measure pain intensity. It is a valid and reliable scale for pain intensity measurement, (
5 min
Modified Rasmussen Radiologic Score
Time Frame: 5 min
This chart is valid measurement tool for assessing fracture healing
5 min

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Universal Goniometer
Time Frame: 5 min
This tool will be used to measure ROM of knee flexion and extension. The goniometer is a 360° protractor with one axis that joins two arms; a stationary arm and a movable one around the fulcrum of the protractor, (Figure 6). It is a valid and reliable tool in measurement of knee ROM (Acar et al., 2024).
5 min
Arabic version of the Knee injury and Osteoarthritis Outcome Score (KOOS)
Time Frame: 5 min
This scale will be used to assess function. The KOOS scale's creators demonstrated the scale has excellent internal consistency, test-retest reliability, construct validity. In addition, it has responsiveness to variations in bodily function (Torad, A et al., 2015). The KOOS-AR is a valid indicator of activity limitation brought on by musculoskeletal problems of the lower 27 extremities. It also has excellent internal consistency and test-retest reliability with relatively small measurement error, (Appendix II), (Almangoush,.,et al., 2013).
5 min

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Investigators

  • Principal Investigator: enas fawzy mohamed, phd, Enas.fawzy@pt.cu.edu.eg

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 1, 2024

Primary Completion (Estimated)

November 1, 2026

Study Completion (Estimated)

November 1, 2026

Study Registration Dates

First Submitted

November 19, 2025

First Submitted That Met QC Criteria

November 19, 2025

First Posted (Actual)

November 26, 2025

Study Record Updates

Last Update Posted (Actual)

November 26, 2025

Last Update Submitted That Met QC Criteria

November 19, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • tibial plateau early rehab

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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