Is Brace Protection Necessary after Fulkerson Osteotomy? A Case Series with Immediate Pain-tolerated Weight Bearing and Range of Motion without Brace Protection after Fulkerson Osteotomy

Abstract Background: Patellar instability is commonly associated with abnormalities such as pathologic tibial tuberosity-trochlear groove (TT-TG) distance. Fulkerson osteotomy is a surgical intervention designed to address these issues by realigning the patella through anteromedialization of the tibial tubercle. However, postoperative management, particularly brace use and rehabilitation protocols, remains a subject of debate due to the concerns over complications such as arthrofibrosis and delayed recovery. Objectives: This study aims to evaluate the safety and efficacy of an accelerated free range of motion (ROM) rehabilitation protocol without brace protection following Fulkerson osteotomy for patellar instability. Materials and Methods: A retrospective case series was conducted on 10 patients (median age: 45.5 years) with patellar instability and TT-TG distances >20 mm who underwent Fulkerson osteotomy. Patients were allowed immediate postoperative weight-bearing and unrestricted ROM based on pain tolerance, without brace protection. Preoperative assessments included TT-TG distance, ROM, and pain scores, whereas postoperative evaluations included radiographic and clinical assessments at 1, 3, 6, and 12 months. Results: Postoperative outcomes demonstrated significant improvements, with median TT-TG distance reduced from 21.95 mm to 9.95 mm and ROM increased from 0°–90° preoperatively to 0°–111°. Pain scores decreased from a median of 6 preoperatively to 0.5 at 6 months. No cases of recurrence instability, delayed union, nonunion, or arthrofibrosis were observed within the 1-year follow-up. One patient with severe preoperative osteoarthritis required patellofemoral joint arthroplasty postoperatively. Conclusions: A pain-tolerated, free-range-of-motion rehabilitation protocol without brace protection after Fulkerson osteotomy is a safe and effective approach. This protocol facilitates faster functional recovery, reduces complications such as arthrofibrosis, and challenges conventional postoperative strategies. Further studies are necessary to validate these findings in larger patient cohorts.