Thank you for reaching out to me...truly I lived on this site during my darkest months and received so much knowledge, reference, and thus help seeking my plan of action! Sorry we are having to connect through the misery of this kind of injury! For me personally this injury has been one for the books and the time frame has been 16 months to feel back to normal. I will try not to be too wordy, but will also try to give you a lot of detail, for I know I relished reading about anyone and anything who might have traveled the same path.
After my injury the emergency OS stated it could be 1-2 years before I was walking normally. My patella was comminuted and displaced and I had substantial soft tissue damage. I had gone to the emergency room and within 2 hours had surgery which lasted nearly 3 hours- entailed cerclage wire around the patella, figure 8 wire on top and two pins running through the patella and I was put in a brace. I was sedated pretty heavily and was in and out of consciousness for 2 days with a spinal block on my leg. I was not put on a CPR since I was not to bend the knee.
I was non-weightbearing for 8 weeks and mostly laid around on a futon. This was through the Christmas holidays (injury on Dec. 20 out of hospital on Dec. 24). Looking back everything seemed so surreal and like an out of body experience. Prior to this injury I had 4 other sports related injuries including full ACL reconstruction, but none of that could prepare me for what this recovery would entail. Research shows this injury to often be from a car wreck or an extreme sports injury. I was definitely shell shocked.
Five weeks after surgery, I started PT. I work in an awesome rehabilitation and sports performance center with great physical therapists. Most had not worked on a shattered patella due to the rarity. The goal of this early physical therapy was to passively move the patella and activate the quad. At this point I feel i developed a bit of a phobia and was really protecting my knee by ensuring i did NOTHING to activate it or move it. My OS said people with traumatic injuries can go through this and usually gets better around 6 months! Therapy was spotty and I really just wanted to protect the knee from any possible movement or impeding the unionization of the patella. I believe my doctor and therapist went easy on me probably because of my worry. However, when I became partial weightbearing at 8 weeks, it was easy to see my knee was not going to bend. I was around 40 ROM Flexion- my extension had not suffered especially since my leg had been kept in the straight legged brace.
Even though my brace had been manipulated to give more and more flexion, it didn't seem to help. My knee was extremely swollen, oftentimes hot and felt as if there was a tight band at the top of the knee. I kept telling my therapist that my knee would not bend and he kept encouraging me that we would get there...one day, he put me in a wheelchair and i pushed a small block up against the wall with my toe and the back wheels of the wheelchair came off the ground showing there was some kind of complete block that would not let me bend the knee. There was definitely a hard stop.
By May(5 mos) my flexion was around 60+ still walking stiff legged, couldn't do stairs, leg still swelling and feeling hot so and I started hydrotherapy and being in the pool was very liberating. I felt some normalcy and the therapy felt great while in the water. My flexion improved little by little, but still very limited and the "hard stop" was still consistent. I stopped going to regular PT due to very little progress and it oftentimes caused the knee to be inflamed and just continued swimming on my own at home.
My OS said we needed to make a decision by 6 months to go back in and "look around" in the knee to see if it was arthrofibrosis impeding my recovery. He explained what he could do in surgery, but stated that "he couldn't guarantee anything could be fixed to help the flexion". So it was then I decided that I needed to seek a specialist who worked on this kind of complicated knee on a daily basis. I had been doing A LOT of research and my PT told me medical journals, papers, etc., to read for factual info. In fact from all my research early on, I am the one who brought up arthrofibrosis to both my PT and doctor. I just knew what my knee felt like and never seemed to be able to convince them that I wasn't just protecting the knee, but that I had a hard stop and there was no way my knee was going to bend no matter what therapy was done.
In June I went to the Steadman Clinic to see Dr. Millett (travelled 13 hours). He felt the wires in my knee were really causing most of the issue, but I had developed Patella Baja and arthrofibrosis. He felt he would have no problem getting my flexion to 120- which is functional (can do stairs) even though not complete. 140 is normal and my other knee is at 145. I was to be operated on in July, but due to work commitments, I had to reschedule until September. On the 12th I had surgery in Vail with Dr. Millett. I had an open knee and arthroscopic procedures done during the surgery ( for the open knee he used my previous scar but did not have to open the entire scar). Once he got in the knee he said he couldn't take the long pins running through the patella out for it would have caused more damage to soft tissue. So I had cerclage wire and the figure 8 removed, patella baja corrected, lateral release, retinacular repair, meniscectomy, lysis of adhesions, and an MUA. I woke up from this surgery in a CPM yet felt great and ready to walk, in fact I was supposed to stay overnight and they agreed to let me go since I felt so good, could walk (with crutches) and even stepped up a box and stairs to show I was good. They sent me to the condo (stayed in Vail for 16 days) with serious pain medication. I took it once overnight and at the PT appointment the next day, I was dizzy from the meds and never took anything else besides a couple of tylenol the next day. My knee just DID NOT HURT! The way I came out of surgery and then not needing pain medication excited me and I think put me in a state of mind of readiness to kick this injury to the curb! Dr. Millet did say that once he got in the knee I had a lot of arhthrofibrosis in and out of the joints, in the supra-patellar pouch, etc.
PT started immediately the next day with a passive therapy- knee mobilizations (the #1 exercise) and quad sets. I went to therapy 2 times a day, 7 days a week for about 3-4 hours total. I also had a plan to work on at the condo. The days ahead were all about rehabbing my knee and I probably spent 6-7 hours working on my knee both in PT and at the condo. I did A LOT of knee slides on the wall, quad sets, knee mobs, etc. In therapy I had 2 therapists...they said it was the goal that PT should never be painful and truly it never was. They didn't want to inflame the knee or cause swelling- it was essential that I not overdo anything to cause it to swell. I absolutely had to use my crutches and was not supposed to walk on the leg for 7 days...even though I felt as though I could. I felt like this was slow progress but soon realized this is the way to heal a traumatic injury that is prone to AF by decreasing swelling and heat of the knee.
I left vail with 120 flexion- my extension wasn't quite as good before my surgery, but it hasn't been an issue. The Steadman Clinic sent a very specified PT plan with NO resistance or weightbearing exercises until 6 weeks. My PT was astounded that I was not to do any weightbearing exercises. I got a recumbent bike for home and rode it with NO RESISTANCE every day for long periods. I slowly watched the progress of the flexion and it seemed that everyday I was able to move the seat closer and closer. I also rode my bicycle outside. When I could start weight-bearing, PT added squating wall slides, band exercises, walking stairs, and a few leg machines with light weights, but honestly I kept riding my bike with some tension and started walking for exercise. I also iced my knee consistently and started wearing a compression sleeve to help with swelling. If therapy caused swelling or the knee to heat, we completely backed off any resistance. I kept doing quad sets, stability ball rolls,etc., at home and my family did A TON of knee mobs to keep the patella from anchoring down.
I have a very active job so I quit going to PT and started doing the strength training on my own. My quad is still quite atrophied, but I can do lunges, squats, walk stairs (I can even run up and down the stairs BUT I don't do this often or for exercise..just know I can because at work I have tried it.) Walking stairs is huge...I was complete incapable at doing this before my second surgery.
I can send you my PT protocol at home and at the therapy center if you would like to see it (my email is [email protected]
if you want to contact me). I am willing to share as much information as you would like! Honestly, knowing others walked (well okay..limped) a similar path as mine kept my hope alive and was information I craved on a daily basis!
You can find me on facebook https://www.facebook.com/holly.berry.395
I posted a lot about the journey, plus I am a member of an arthrofibrosis FB.
Dr. Millett's article...my knee was mostly rehabilitated like this ( I gave this article to my home PT and she was very interested in it).http://drmillett.com/wp-content/uploads/articles/Rehabilitation%20of%20the%20arthrofibrotic%20knee.pdfhttp://www.wosm.com/wp-content/uploads/2014/11/Arthrofibrosis-of-the-Knee-Journal-of-the-American-Academy-of-Orthopaedic-Surgeons-2007.pdf