Broken Patella Recovery

[jamorgan3777]

Hi all,

This is a great site.  Good place for people to get together and share experiences.  Here is mine.  I would love to hear any and all feedback on personal stories and advice on how I should proceed.

Here is my tale...

I am a fairly healthy 37yo guy.  I have in the last year taken up running.  I am what you would consider a clydesdale (5'10.5" 225lb).  I run mainly on trails and average 15 to 20 miles per week.  Over the last 4-6 weeks before my fracture I had been experiencing knee pain right on my knee cap.  I would run, it would hurt, I would ice it, rest a day, it would be fine...repeat.  I did that for a while.  Then I had two or three episodes where I would catch it just right while running and it would really hurt for a few minutes, then be okay (say go to pain level 6 for a few minutes, then back to a 3).  This happened 3 times that I can remember.  Anyway, on one of my off days I went mountain biking with some friends and had to dismount my bike due to an obstacle in the road.  I was wearing clipless pedals at the time and when my leg came out of the pedal I felt my knee cap snap and heard a sound like crunching cartilage (in mid air mind you).  When I landed, I looked down and saw my knee cap was in two pieces.  Weird thing was, very little pain, just a weird pressure.  I was able to push the two pieces of bone back together, wrap it all with a belt (once above and once below the knee cap to hold it together) and push my way to the road on my bike. Anyway, the point of this long story was, the Doc and I think there was a stress fracture in the patella that just snapped.  A week later I had ORIF with two annular screws and a compression wire (figure 8 style).  I am now 2.5 weeks post surgery.

For lack of a better way, I will just list my observations/experiences.

1.  Very little pain with the whole incident.  The ER staff kept asking me what my pain level was and it was 0-1 through the whole visit (except when they made me bend it for the one x-ray).  Also, very little swelling.  The whole thing didn't get big for at least a couple of days and even then, it didn't get nearly as big as after the surgery.

2.  Straight leg brace between ER visit and surgery.  Initial consult with OS said ORIF and maybe a wire.  He later decided I looked like I would do "too much too soon" so he put the wire in for safety sake.  Surgery lasted about 1.5 hours.  At the initial consult, I asked if he should/could look around in there to check for additional damage.  He said he would.  Good thing he did too.  He found and repaired a small meniscus tear (cant remember which side).  Later he said it was good I "bullied" him into doing the scope or he might not have found the tear (bullied was tongue in cheek of course )

3.  After surgery there was a large amount of swelling on the knee itself and some amount in the thigh and calf.  This was pretty bad for 3-5 days post surgery, but has gotten better with time and elevation.  Post op pain was very minimal.  I was taking 5mg Oxycontin for a couple days, then realized I was waking up with no pain, so I gave them up.  Been on tylenol and ibuprofen ever since.  I also have been able to put full weight on it (in the 0 degree locked ROM brace) since about day 3.  I ditched the crutches about day 5 and have been peg legging it every since.

4.  2 weeks post op I visited the Doc's PA and she said things looked good on the x-ray and that I could continue without crutches as long as it was locked at 0 degrees.  Then with no weight I could try and bend it.  I would wait to start PT until week 3 post op. 

5.  I started bending and have (according to the brace) 30 degrees of easy ROM and can get to 40 if I push it.  No real pain, but a lot of pressure because its still pretty swollen and very hard.  I am surprised at how hard and warm it is.  I initially thought that the warmth was a sign of infection, but reading and a call to the Doc's nurse assured me that it was part of the process.   

6.  Now it is hurry up and wait for the next Doc visit in another week (will be 4 weeks post op).  Still in ROM brace and still no driving (although I am going to give it a whirl this weekend since I got the 30 degrees of easy motion). 

7.  Can't wait to start more exercises.  Come on PT, the faster we get started, the faster I can get back on my bike and back on the trail...

Please anyone/everyone, I welcome your thoughts, comments, personal experiences...

Thanks for reading,

Jason

[etta]

Hi Jason
You certtainly are coming along very well after your surgery. Keep up the good work. My diary on here is titled "Broken Patella". You will see from my diary what I have been through. My break was 2 years ago last month and I had the wires out a year this month. A lot of healing takes place and I still cannot kneel on my knee - I was told it can take up to 2 years for me to be able to do this. When I fractured my kneecap it was broken in about 6 pieces and they were all wired back together. The pain I felt at the time was unbearable, I see you had hardly any pain, just as well. When the ambulance arrived to take me to hospital they gave me the gas where you breath it in all the time, if you stop breathing it in the pain comes back. In hospital I was put onto morpheine and after the op 2 days later I was put onto a morpheine drip for about 3 days.
I have got good extension on my knee, able to bend it really well. Exercising is a must to get the muscles strengthened as I daresay you have been told.
I am much older than you so you should heal much quicker than me.
Keep up the good work, you will get there eventually.
Etta

[jamorgan3777]

Just had 4 week post op with the OS (or rather his PA).  Anyway, they say things are healing nicely and from what I can see, the fracture appears to be almost fused.  Need to be in the brace peg-leg for 2 more weeks, then I think I will be able to get rid of it.  They increased my ROM stop on my brace to 90 degrees and said I can start working on getting there.  Not to force anything, but I was getting 50 really easy.  I think 50 to 90 is going to be much harder.  I do not have pain, just a lot of pressure right at the base of my thigh muscle.  almost feels like it is pinned down.  I can't believe how much muscle mass I have lost in the 5 weeks since the break.  I had quite muscular quads and hamstrings from the running and biking I was doing, now I have one "normal" thigh and one that is a shell of its former self.  I have noticed from the scale that I have actually lost 4-5 lbs since the break and I think most of that is thigh muscle.  I am also amazed at how weak it is.  I think just doing a single leg lift is going to be a real workout. 

Will post again in another couple of weeks. 

[etta]

Hi. Carry on the good work - you will get there eventually. Yes the muscle wastage is a real pain, in you case because you are so fit you should get it back to normal in no time. As you are much younger than me the recovery time will be much shorter. My leg is still weak from the break but am able to do most things except kneeling as I was told by the surgeon it will be a good year before I can kneel on the properly as there is not much blood flow in that area hence the time it takes longer in the healing process.
Etta

[Cankneedian]

Hello Jason!
I too am recovering from the same surgery. I tore the patella from the bone back in June 5/09., had surgery June 8/09. I am also 37 yrs. old, 6 foot, 255lbs & very athletic. Unfortunately my injury happened falling down my basement stairs. I was put into a cast from my ankle to upper thigh for 6 weeks, had it removed after 5 weeks then was prescribed a flexion brace set at 15 degrees for 2 weeks & moved up every 2 weeks after that throughout my PT. My OS was awesome, my therapist is excellent. I am now 20 weeks post op & getting stronger everyday, ROM is 108 degrees unassisted, thigh muscle back to it's tree trunk status, hamstring still needs some work. Sounds like you are coming along pretty good, keep it up....remember... stick to the therapy religiously, stay positive, be patient. If you have any questions at all, I will gladly answer them!

[sabasc3]

Hey Cankneedian,
Jason and I are on similar paths since we both had similar repair (wires and pins/screws in the patella) on the same day

Sorry to hear you fell down your basement stairs - ouch!  I hope they weren't concrete! 
It's encouraging to hear your quads recovered so quickly (at ~5 months). 
I assume you are walking pretty normally again, and just working on increasing ROM and hamstring strength?
Did you experience much pain after surgery?  If so, how is it now?
Scott

[jamorgan3777]

Had my 6 week follow up yesterday.  Things continue to look good and the OS released me from the brace.  Said I can "do whatever the knee will let me".  He said that structurally I am "whole", but I will need a lot of work to get back to "normal".  No more brace, can drive again (legally) followup in 4 more weeks.

Also started PT.  Not too sure I like my therapist, but we'll see how it goes.  First session was mostly assessment related, although he did give me different exercises to do.  Assessment is as follows.

1.  Good leg has -8 degrees "hyperextension" bad leg has +2 - need to work on extension of bad leg to match good one.
2.  Good leg has 130 degrees of unassisted bend, bad leg is at about 90 - need to get bad leg to match good one.
3.  Work on overall joint flexability
4.  Work on rebuilding quads and hamstrings.
5.  Wait another week before trying any exercise equipment.  Not because I shouldn't do it, but because you don't want to try too many new things at once, if something starts to aggravate the knee, then I wont know what to blame it on.

Exercises:

1.  Straight leg raise - lay on back, bend good leg to 90 degrees with foot on floor, raise bad leg up to level of knee on good leg with 0 degree flex.  3x sets of 10
2.  Heel slides - Lay on back, slide heel of bad leg toward butt.  Do 10 to easy resistance angle, 10 to med resistance angle, and 10 to hard resistance angle
3.  Calf stretches - Sit with leg extended flat on floor, get towel or belt and pull ball of foot back toward knee while pressing knee downward into the floor.  Hold for 30 sec. repeat twice
4.  Hyper extensions - Roll up towel, put under heel.  Put ice on knee and press down knee to floor/let gravity pull knee to floor.  Hold for 15 min.

Will update with progress as I get some...

[louisbest]

Hi Jason,
I fractured my Kneecap on the 26 Oct. From looking at my xrays its looks like a clean break at the bottom of the Patella the break is displaced though. I also have had very little Pain. I broke mine at work and carried on working for another 2 hrs before I went to hospital (keeping my leg straight at the time bending was very painful) It was painful when I initially broke it but that pain subsided pretty quickly. Even in hospital The pain was a one level. I haven't even had any painkillers since coming out.
I haven't had surgery though just a full leg cast.
I think the surgeon wanted to avoid surgery at all costs as he was very busy ( That's the NHS for you )
Im only 23 fit and healthy. I was supposed to flying to Malaysia for a year of travelling on the 16 Nov. I cant now but would really like to go in December. Whats the quickest healing period anyone has heard about?
Im currently on crutches but have been told my leg is weight bearing. So ill hobble around my flat with no crutches sometimes.

When I first got to hospital I couldn't straight leg lift so the worst was assumed. After a night in a cast in Hospital I regained my leg lift in the morning. Thats what saved me from surgery.I can only think some swelling may have stopped my straight lifting at first? the swelling was minimal though.

Its just weird how I have felt no pain really?

Hope your better soon ill race you to recovery.

Louis

[jamorgan3777]

If your break is displaces, How did you get away without having surgery?  That is the reason I HAD to have surgery.  Anyway, at 6 weeks I could get rid of my brace and could have flown/traveled.  After about 3 weeks, I could bend my knee enough that I could have gotten around on plains trains, and automobiles.  I even started driving after 3 weeks, but that was all with surgery and the knee cap fully pinned together.  If your break is "set" correctly as I assume it is, you should be able to bend it after 6 weeks I would think. 

Good luck with your recovery.  Let me know how your healing goes.

[jamorgan3777]

Hi all,

Another visit to PT and more progress.  One of the things I was kind of disappointed about with my first PT visit was my therapists "negative" attitude.  He was very pessimistic and wanted me to "not get my hopes up" about a quick recovery and getting back to "100%" of what I was pre-injury.  It seemed like he wanted an out for any little thing that might go wrong in my rehab.  Well I think that all changed after this visit.  He saw my progress and was much more upbeat and optimistic (maybe he was just having a bad day).  Anyway, in a week of doing my exercises twice a day I have gone from +2 degrees extension/90 degrees flexion to -2degrees extension/112  degrees flexion.  I am starting to take stairs and have even gone on a trail hike.  Strength is returning and I can feel my quads starting to build (although I am really amazed at how much muscle mass I lost). 

New exercises are as follows:

hip flexors - stand on stair on bad leg and hang good leg off to side, then lower and raise hip in a "shake your butt" motion.  Really works glutes and IT band (surprisingly so) .

stir steps - step up and down a stair on bad leg in a slow controlled motion.  Mostly trying to build muscle memory, but it also works the quads. 

Start working on the stationary bike - will likely get a bike trainer for this.

assisted squats - machine that lays you down on your back at about a 10 degree incline and you to a leg press.  Will build resistance as we progress

Keep doing the following exercises:

Leg lifts
heel slides
calf stretches
hyperextensions

Going to go this thursday, but will then cut it back to one session per week.

will report back more next week.

[Karen S]

Hi Everyone... Thanks for posting its interesting to hear everyone's stories and progress.. Here is mine.

Six weeks ago was on my last day of vacation in Mexico when I slipped at the resort and fell directly on my left knee breaking the patella in half. Not a ton of pain but intense pressure and not able to straighten it..Pain when they moved me.. So that night emergancy surgery in Cancun..delayed coming home for three days, but flew home in a leg stabalizer..not the most comfortable thing I've ever done but at that point I just wanted to be home.

I came home with the xrays so I was able to take these to an orthapedic dr to get going on my recovery here. Pretty much it looks like a figure 8 configuration.  About week two I loose the crutches in the house, wk four I see the dr she says she'll see me in two weeks and in that time she wants the crutches gone and the stabilizer too..and sets  me for therapy. 

It took me a week to get a therapy appointment, and that was just the evaluation..the following week I could only get one therapy apppointment which got me going , but I was a little frustrated at not being further ahead.. so at my next appointment i ask for more appointments and last week I had five straight visits.  it was tough, and by friday I was hurting...but in one week I came from bending at a 50 to 70..
 
At the theraphy sessions we heat pack the knee for 10 minutes, then I am on the bike trainer for 7 mins..I was able to move it up a notch yesterday as I had more flex than last week.  We then do a lot of thigh building lifts and various exercises, then we heat pack for another 10 mins and my therapist stretches my leg out by having me lay on my stomache and she bends my knee  up ..the pain is intense while we do this, the minute we stop so does the pain  . Sessions are usually one hr.. I have three this week.

 I am now driving myself which this helps, but am off work for another 4 wks..that is driving me crazy... 

One question I have when I bend my knee I can feel the whole wire configuration on the knee cap..Is that normal? Is everyone else experiencing that?

Keep Posting Guys.. It helps to know what is working or not for people.. Heal Quickly!

Karen S

[jamorgan3777]

Hi all.  Thought I would post an update after my 10 week post-op visit this morning.

All in all things seem to be progressing really well from a recovery standpoint.  I saw the OS (his PA anyway) and they said everything looks good and structurally I am cleared to do any activity I was doing before my injury.  She said not to go out and run a marathon, but at this point the hardware is not doing anything and I can do any activity that I feel up to (or more appropriately, that the knee will let me do).  I was really worried about when I could start running again, and they gave me the green light.  Again, this came with the caveat of take it slow and dont try to do too much too fast.  They said, however, that I should expect to be back where I was before once I regain strength in the leg and joint. 

Here are my current statistics and observations, again this is 10 weeks post surgery and 11 weeks post injury.

Range of Motion is from -2 degrees extension to 135 degrees bend - this is about 5 degrees less total than the good leg and mainly in extension (good leg goes from -8 extension to 135 bend)

Swelling is slowly reducing, but the knee cap is still ~2x the size of the other (good) one.

Center of the knee cap is still numb to the touch, this numbness is likely to take a while to go away.  Kneeling on the injured leg can be done, but isn't what I would call pleasant but not as bad as I thought it would be.

Strength of the injured leg is slowly returning.  I have graduated from the "beginner" exercises (leg lifts, heel slides, etc) to the "intermediate" exercises (squats, lunges, incline sled, etc.)

Stairs are still pretty tough going down and okay going up.  Going up I get a little soreness in the tendons on both ends of the patella.  Going down stairs this is amplified.  If you think about going down a stair, for some amount of time, your entire body weight is supported by your knee in flexion.  I just do not have the strength yet to do that.  Going up stairs you can use the good leg for a boost and that makes the difference.  I am however able to do the stairclimber and will be working that into my aerobic routines more and more. 

I am also starting to increase aerobic activity.  I am up to ~20 min on the stationary bike and ~20 min on the elliptical.  I have not tried running or jogging yet.  I have started single leg intervals on the stationary bike and I can feel that those are going to help build muscle quickly.

I notice that I have new aches and pains in different areas as I push the limits.  These always go away after 3-5 days of repteition or 1-2 days of rest.  Doc says that as long as they are coming and going they are normal.  If anything comes and stays, then we should investigate.

OS is done with me unless I have questions or run into any problems.  No further appointments needed unless I have issues.

PT is still working with me.  I go once a week, get a new round of exercises, do those for a week and then reassess. 

More later...

[louisbest]

Hey I posted earlier. glad to see you are still having improvement. I broke my Patella on the 26th of Octber. As I mentioned earlier I did not have surgery even though it was a clean displaced break. Im supposed to be in a straight leg brace now but I dont wear it. Dont use the crutch either. Its still slightly swollen but has re gained allot of movement. I can even get a little jog going on and drive. I can manage steps up and down with a normal stride (just). I manage to walk with only a hint of a limp.
Im really happy with my recovery. I think the secret to a speedy recovery is naughties with your girlfriend or partner. Its the best PT possible
I start my first proper PT in 4 days so hope that will give me more movement. I think Im a long way from kneeling at the moment though.
My thigh has wasted away allot. Cant wait to start those lunges and squats you mentioned.   

[debinmd]

Just found this site and would like some advice as my doctor is useless.  I broke my patella vertically on 10/10/09.  I was told that this is an unusual break.   I wore the brace and kept my leg straight for 4 weeks without any healing.  On 11/16/09 I had surgery and they put in 2 pins.  I had the staples removed 1 week later but my doctor does not want me to start PT yet and I am not returning to his office until 12/15/09.  He wants me to release the brace and let my leg hang at least 4 times a day.  Dangling I am able to bend it at about a 60% angle (don't know the official measurement).  Sometimes that angle feels good and other times it hurts like hell.

My question is that it has been about 2 1/2 weeks since the surgery and I still have a lot of swelling around the knee and in my ankle/feet.  I also have numbing/tingling from my upper thigh to my knee.  Is this common and if so, when does it go away?  I think that it is related to the knee swelling which I thought would be going down by now. 

I'm also having horrendous sciatica and hip pain from having to wear this brace and keep my leg elevated.  Has anyone else experienced this and if so, what did you do about it?  I'm about to try acupunture.

[Karen S]

I Have the same fracture  as you do and on the same day!..I had mine pinned though that day.. Swelling is normal..and can be for several weeks..I have been numb on the patella it's self..but that is getting better...I was in a stabalizer for 4 weeks then could bear weight.. Have been doing Therapy to get the flex back and the bend.. I am doing pool and land therapy and have been off work since 10/10... My flex or bend is slow in returning only at 84  and over 90 in the pool..

Karen S