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Author Topic: Patella fracture while recovering from ACL reconstruction. Recovery time??  (Read 1256 times)

Offline Mxline167

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Wanted to see if anyone has had the same problem. Was 10 weeks post opp from acl reconstruction using patellar tendon, was walking down stars and slipped which resulted in traversed patella fracture. Had surgery 1/18/17.  Just trying to get some info and what recovery will be looking like!!

Offline Liblet

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Re: Patella fracture while recovering from ACL reconstruction. Recovery time??
« Reply #1 on: February 13, 2017, 03:22:04 PM »
Hi, sorry to hear about the fracture.  Was it displaced and needing surgery?  Patella fractures take an awfully long time to heal.  When I broke mine in November, all the advice I got was to be patient.  Everyone's story with this break is different.  Have you been put in a fixed brace, if so for how long?  My fracture was comminuted and now just over 3 months later, I am walking (without aids or a brace), albeit slowly, with the feeling that my leg doesn't really belong to my body!  One of the main problems with this fracture is the Quad muscle loses all its tension and strength and I think this will take months and months and may never be the same as the other leg.  I still get some pain, especially at night and have to take medication.  I am doing physio every day (homework), only see the physio once a week.  I also go to hydrotherapy 3 times a week, I think this has really helped and if you can get to a hydrotherapy pool, I really would recommend it.  When I have been exercising and the knee starts to swell and hurt, I use a cryocuff system, brilliant.

Good luck and be patient and try not to do too much too soon.

Offline Mxline167

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Re: Patella fracture while recovering from ACL reconstruction. Recovery time??
« Reply #2 on: February 13, 2017, 08:35:28 PM »
Hey Liblet, thanks for the reply,
So it was displaced, had surgery on 1/18 2 pins and wire. I had full range of motion from my previous acl surgery which was good but my quads was still pretty weak. I will be 4 weeks post op tomorrow and have doc app Thursday. So hopefully everything is healing ok. But yes I'm learning that PATIENCE is key.. Just gets really tuff after being out since November. Also I am in straight leg brace and on crutches with minimal weight bearing. Doc says I can go back to work by middle of May, I'm an electrician, so hope that is realistic!!

Offline Liblet

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Re: Patella fracture while recovering from ACL reconstruction. Recovery time??
« Reply #3 on: February 14, 2017, 04:18:51 PM »
Hi,  Good luck with the doc's appt.  Please don't panic when they take you out of your straight leg brace because you will almost certainly have lost ROM and even more Quad muscle.  It will come back slowly.  I am now on 125-130 ROM 3.5 months out and I have really worked at it.  Also you probably won't be able to walk up and down stairs normally, this takes some time.  I am just starting to go up in a relatively normal fashion (about 7 steps at a time) but there is no way I can go down normally.  I have been told this could take a good year or even never be achieved!!  I am sure you will be able to go back to work in May but I would probably avoid any ladders!  Good luck, let me know how you get on.

Offline Buckeyegirl80

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Re: Patella fracture while recovering from ACL reconstruction. Recovery time??
« Reply #4 on: February 15, 2017, 09:39:39 PM »
Hey there,
 
Good Luck at the doctor this week.  It will be weird to take the brace off, but that is progress. 

I am 6 months out from breaking my left patella into 5 pieces.  I had surgery for 2 pins & wire and was in an immobilizer for 7 weeks.  I was weight bearing, but no bending at all.  I lost a lot of quad strength over that time for sure.

I started PT at 8 weeks post surgery and was able to get to about 110 ROM, which took about 8 weeks.  Once I started therapy, I was walking very well (not fast), but minimal limp.  PT was a huge help on getting movement & strength back. 

The hardware was hindering me going further with my ROM, due to the pain and tightness I had with  PT and bending my knee.  I actually had surgery last week to remove the hardware and I feel that it is a success so far.  Of course, I'm not bending much yet, due to stitches, but the tightness and pain is better already. 

Good Luck and it does take patience to get through it.  I was surprised at the time & work it took to get back to a normal routine.   

Lisa

Offline iamhealing

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MXLine-- I am the patella fracture story you don't want to hear.

I fractured into 3 pieces had pins and wires to put together.

My doc was very conservative with me and kept me at 0 flexion for at least 2 months. But I had weight bearing as tolerated from beginning.

Are you using a cpm -continuous passive motion machine. I wish I had as people seem to start therapy with a nice range of motion about 60.

I started PT with a very low rom, can't recall exactly maybe in 20-30.  At 4 months , I have worked so hard just to get to 68 and it was a huge strain to get there. Pain in physical therapy worry they would break my leg.

I also have lateral patellar femoral incongruity after the surgery and this is distressing as it grinds.

So I am off to see a specialist soon about the lack of progress and the incongruity.

My advice do passive motion machine if available to you.


Offline iamhealing

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LIblet--you mentioned hydrotherapy as helping you- I really need some progress with ROM. Could you describe what you do in the water on this thread or start another here?
A million thanks in advance.

Offline Liblet

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Hi,  It is very difficult to advise as everyone is different and their progress can be slower or faster.  First of all I checked with my OS that I could start hydrotherapy and he was happy for me to start at about 2 months.  I did a great deal of research and managed to find classes, which are properly supervised with a Osteopath designing the exercises and an instructor in the pool to make sure that the exercises are being done correctly.  I also checked with my physio that the exercises were correct for my level of recovery.  Cycling in the deep end seems to be the most helpful for ROM.  Also the water must be warm, so that the muscles can relax and you don't get cold.  I don't know whereabouts you are, I am in UK.  Do your research and check with your OS that this form of treatment is right for you at this time.  Good luck.

Offline iamhealing

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Liblet thanks for your response.  I was cleared for hydrotherapy sometime ago but it was felt PT on land would give better results at the time.

Now where PT on land is just too painful to endure (I think scar tissue is blocking progress), I just have to try something else though I will see an arthrofibrosis specialist very soon.

When you say cycling in the deep end - were you able to do this when your rom was more limited? Or, is that only possible when you can go fully round?

Offline Liblet

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Hi,  I started the cycling with very limited ROM, just doing what I could, very slowly.  Over time things have got better and I can even swim breast stroke!!!  Being in warm water will give you lots of confidence, without the pain, your muscles will relax and you will be able to move.  At first just do what you can and things will get better.  My OS was happier for me to do exercises in the water rather than on land.  I credit the hydrotherapy with giving me back almost 100% ROM.  Go for it, I really hope it helps.

Offline hberry

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It has been 15 months since my devastating injury in December 2015. I have had two surgeries, the last one at the Steadman Clinic, which I credit for giving me back my flexion and thus my active lifestyle. My flexion was stuck in the sixties for nearly 9 months before my second surgery in Vail. I had a VERY SPECIFIC rehab after that second surgery. When I returned home, my PT was very confused and surprised about how my therapy was ordered to progress by the Steadman PTs.

I would be happy to share my therapy and anything else that may give anyone hope, because I certainly know what it felt like feeling I would never walk normally much less be as active as my job and life was before the accident.  My knee developed arthrofibrosis and my second surgery entailed 6 procedures...but from the moment I woke up after surgery the progress was amazing!
« Last Edit: March 26, 2017, 08:57:27 PM by hberry, Reason: Addressed it to the wrong person. »

Offline hberry

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Sorry I originally addressed my previous post to the wrong person, I meant to reach out to "iamhealing" since received a message from that person. I am unable to reply to your message in my inbox for some reason, so let me know if you would like to communicate here. I know reading info at this site is basically what got me through a very dark scary time with my patella fracture and led me to the Steadman Clinic. 
« Last Edit: March 26, 2017, 09:00:12 PM by hberry, Reason: Addressed previous post to the wrong person. »

Offline iamhealing

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hberry-

Thanks for reaching out here.  I think you cannot private message until you have 20 messages.

Would you share information here regarding your patella fracture recovery?  I finally made some progress at PT getting to 86 this week! But I will still be traveling to the Steadman clinic for evaluation due to lateral incongruity. 

Could you indicate whether your surgery at the S. Clinic was just for arthrofibrosis , or were there other issues that had to be dealt with as well.

Also would you share how your PT progressed after surgery?  How long did you stay in Vail  and how was the PT different from the PT you had received previously?

Thank you so much  for responding and I look forward to learning about your experience!

Offline hberry

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Hi Iamhealing,

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.pdf
http://www.wosm.com/wp-content/uploads/2014/11/Arthrofibrosis-of-the-Knee-Journal-of-the-American-Academy-of-Orthopaedic-Surgeons-2007.pdf

Offline iamhealing

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Thank you so much!  It is quite late here and I will write more tomorrow but I cannot thank you enough for sharing as you did.  These have been pretty dark days for me and it sure sounds like you know what I am talking about when I say that.