Physiotherapy Protocol for Postoperative Intraosseous Rosai-Dorfman Disease of the Distal Femur: A Case Report

Rosai-Dorfman disease (RDD) is a rare, benign, non-neoplastic histiocytic proliferative disorder. Involvement of the distal femur with intra-articular extension is uncommon and can pose diagnostic challenges. Physiotherapy plays a critical role in postoperative recovery; however, structured rehabilitation guidelines for such cases remain limited in the literature. This case report describes a rare presentation of intraosseous RDD and highlights the clinical outcomes of a phased, impairment-based physiotherapy protocol following surgical excision and bone grafting. The patient presented with gradually progressive left-sided knee pain that worsened over several months. Radiographic evaluation demonstrated a mixed lytic-sclerotic lesion in the distal femur with intra-articular extension. The patient underwent intra-articular curettage with allograft bone grafting; biopsy confirmed intraosseous RDD. She was referred for physiotherapy five weeks after immobilization. Postoperatively, she presented with restricted knee flexion range of motion (ROM) to 70°, extensor lag, fear of falling, swelling in the patellar region, a healed surgical scar, quadriceps and calf muscle atrophy, altered gait, pelvic drop during stance, reduced quadriceps, hamstring, and hip abductor strength (manual muscle testing (MMT) 3-), and impaired proprioception of the knee joint. A structured, phase-wise physiotherapy program was initiated with the goals of protecting the graft, gradually restoring knee mobility, improving muscle strength, facilitating gait re-education, and enhancing proprioception. The patient demonstrated progressive improvement in knee range of motion, muscle strength, gait symmetry, and functional independence without complications. This case underscores the importance of early, goal-oriented, phase-based physiotherapy following surgical management of intraosseous RDD of the distal femur. A structured rehabilitation protocol complemented surgical treatment, facilitating the recovery of mobility and function and helping to prevent long-term disability. This report contributes clinically relevant guidance to the limited literature on postoperative physiotherapy management in rare cases of RDD.