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

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. 

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!

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...

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.