Ruptured Patellar Tendon Surgery

[snoopz_mum]

Third time lucky....

I'm told this is THE place to be..... 

Hello there!

I got knocked off my bike 4th April 2012 and ruptured my (right) patella tendon.  When the surgeon operated he said it was like "shredded wheat" and removed the whole thing, replacing it with "a nylon figure 8" (at least, that's what he told me, I haven't seen an x-ray and haven't seen him since the questions started piling up!).  I am interested in finding out:

1) about the exact surgical procedure (and I will try to get that information from clinic this week too, although haven't seen the surgeon for well over 2 months)

2) about rehab - my initial instruction was "limited to 45 degrees, lifting my knee up in front of me" and I was due to see the surgeon 6 weeks after being given that direction but I got an infection in the wound and a granuloma formed which took 6 weeks to get rid of.  I don't know if that has had an impact on my recovery (had only got 10 degrees by 6 weeks) but I don't have a lot of faith in the advice the registrars have given me (one asked me to straight leg lift the day I had my stitches out, I said I couldn't, she insisted I try so I did only to have the consultant flip out that I was trying with an RPT - she didn't take the blame for me trying!!!)

3) about precautions - is there anything I REALLY shouldn't be doing/attempting.  I seem to be pushing myself more than my physio is prepared to but I don't want to screw things up.  Is walking distance good or bad (I walked 1.5 miles the other day and suffered the next day for it); is climbing stairs good or bad (I can manage a 5" step going up and it feels okay).  The physio won't say anything because neither she nor I have been given direction by the consultant. 

4) has anyone used swimming for rehab?

5) am I going to be able to bear weight on my knee in a kneeling position (ever!)? (important for my job!!!)

Happy days, Any advice/info would be gratefully received.

Many thanks!

[Zlou58]

With this injury patience is KEY!!!  I think if you have a strong leg raise steps might be good but gotta talk to PT and DOC. swimming is great but holds danger inside due to slippery title when getti g out, be really safe!  Kneeling is touchy for some and not others. I'd try a big pad!  Hope this helps brother

[snoopz_mum]

With this injury patience is KEY!!!  I think if you have a strong leg raise steps might be good but gotta talk to PT and DOC. swimming is great but holds danger inside due to slippery title when getti g out, be really safe!  Kneeling is touchy for some and not others. I'd try a big pad!  Hope this helps brother

Thanks for the advice.  I figured that about the pool (safety issues).  I can get up off the floor but it's not very graceful.  I'm told my local pool has a hoist to get disabled people (aagh!) in and out which I would suffer the indignity of (definitely over my getting up from the floor method!) if it's beneficial overall.   

[John42]

Welcome to Snoopz - now you have found the correct thread - kneeling is a bum, but practice in due course, but PATIENCE is required.

Have a look on Amazon for a floor pedal cycle - it`s worth it`s weight in gold.

Sleep with a pillow/cushion between your knees ...

More tips to follow

Take care

JohnK/ Manchester UK

[snoopz_mum]

thanks for the road map/directions JohnK! 

I have had a lot of problems with sleeping.  I sleep on my belly generally.  It's a no brainer that that wasn't possible initially (on several occasions in recent weeks I have found myself on my belly in the night - I'm sure it's not good for my knee and I'm sure getting in that position is what wakes me up!).  I'm still sleeping with a rigidiser brace on (although using a hinged one in the day time).  Initially this was because I wasn't told not to (I have had very little direction about what I should and shouldn't be doing), but on the odd occasions I've dozed off without it on, I have woken up with pain in my knee.  Is the pillow trick (assuming I can keep one in place, I'm a terrible fidget!) helpful for pain?  I've found if I sleep on my left (unaffected) side I can put a pillow in front of me and cross my right leg over onto it (this is my best position for sleeping but I can't always get comfortable in it and it is impossible without the pillow).  If I'm on my right side (which is less comfortable) I have my right knee in gentle flexion (it's happiest round about 45 degrees although I can get 75) with my left knee behind it for support.  I'm not sleeping in the comfiest of beds which doesn't help!!!


 

[tonestone]

1 year mark and guys/gals there is light at the end of the tunnel!!!

I play about 6 to 8 softball games a week and on Sundays I get in 4 to 5 games.  I posted early on that I wouldn’t push it but with the knee holding up great and the fact that I can’t help it (I love the game too much).  I don’t feel pain while or after playing and I’m pretty much back to my old self - I use the patella brace when I play but that is more for peace of mind.  This injury is not something I would wish on anyone, so keep on keeping on!!!!
 
To all the new member’s things will get better and it comes with time, as we all know it’s a long road to recovery.  Patience is the key!!!  Listen to your OS, PT and most importantly YOURSELF it’s your knee.  Keeping a positive attitude is the only way to get by this, remember every person is different so don't gauge your progress against others use what they have done to assist you in knowing that you too will get there with time. 

Good luck and take care

[John42]

Hi Snoopz

Ask your PT a simple question - Have you attended to a RPT injury before?, In most cases the response is "no", that`s why, you can learn so much more from this thread.


Take care

JohnK/ Manchester UK

[snoopz_mum]

Hi Snoopz

Ask your PT a simple question - Have you attended to a RPT injury before?, In most cases the response is "no", that`s why, you can learn so much more from this thread.


Take care

JohnK/ Manchester UK

JohnK, you're probably right but I can't ask her as she's a colleague!!!!  I was fortunate enough to know my physio colleagues so I picked the one I wanted based on her ortho experience.  She is a little afraid of pushing me and (quite rightly) looking to the consultant for direction.

[snoopz_mum]

Another unsuccessful trip to the hospital yesterday.  I discovered before I went that my consultant was (yet again) not going to be there but decided to go anyway (as I was lacking a sick note and hoped that I would be able to get SOME answers from the other consultant on duty who actually IS a knee specialist (my surgeon is a shoulder specialist)).

I gave my registrar a letter from my physio wanting to know how aggressive they can actually be in physio

I asked my burning question which was "should I be worried by my lack of flexion or, given that I had an infection, is my progress okay?"

I asked work's question (which is a silly one) can I resume full duties in 6 - 8 weeks time

and I asked additional questions:

• can I sleep with my brace off?
  can I do steps?
  is it safe to do any mobility with my brace off (as part of rehab)?

I didn't receive any coherent answers.  This is the registrar that, 6 weeks ago, came and scanned my notes, walked into my cubicle and said "get rid of the brace".  After I picked my jaw off the floor  I said "you do realise I've been limited to 45 degrees flexion, do you?"  He went back to my notes then spoke to the other consultant who said that I most definitely should NOT be getting rid of my brace, but the limit could be increased to 70 degrees.  So it was no surprise he came in and said "get rid of the brace" (didn't learn anything from last time then). 

I pointed out that I had quad contracture, my knee has a tendency to 'snap' into extension or flexion and my mobility without a brace is pathetic.  I said while I was more than happy to do rehab around mobility without the brace that I was not prepared to walk without it until my knee and quads were stronger.  He made some comment about "having to let go psychologically" to which I responded that I was not babying my knee and that I was, in fact, pushing it more than the physio is but that I need direction as to how much I can safely push it.  He said "let pain be your guide" (ANY THOUGHTS from fellow RPTs on that?).  Then he said "if we push it too far we can always fix it again".   
That REALLY ticked me off.

So I am going to keep doing what I'm doing and wait till I see the consultant on 2nd August. 

[John42]

Typical rough ride - just remember you are the patient - regardless of your work colleagues, push for better attention, LISTEN to your knee, ASK questions.

Reading your notes, it seems that you are being looked after a bunch of persons who have not dealt with an RPTinjury before.

Keep posting

JohnK/ Manchester

[snoopz_mum]

Reading your notes, it seems that you are being looked after a bunch of persons who have not dealt with an RPTinjury before.

Keep posting

JohnK/ Manchester

I get that impression but I wish they would be honest about it.  I actually quoted kneegeeks a couple of times yesterday as to why I wasn't going to follow his advice! 

[John42]

It`s your knee - keep pestering


JohnK/ Manchester UK

[dieselcut]

Snoopz,
no matter how good a surgeon is, NO ONE wants to operate on the same area twice. Even if he does everything right, there is a chance for infection or the knee coming out worse on the other end due to a whole slew of other problems.
Like John says, pester the absolute hell out of your OS. At the end of the day you are the one who has to walk on that thing and will be dealing with the consequences 24 hours a day. There are never going to be actual randomized studies in patients with infections, because it is rare for an IRB is to approve waiting around to randomize patients once something has already gone wrong; not to mention that most surgeons don't like admitting something has gone wrong with their procedure.
Stay on top of them...
Best of wishes,
Dean

[yellowsteve]

Just wanted to say what an inspiration to find such a relevant and interesting thread at long last! It's a rare and difficult injury/rehab which is backed up by reading on here.

Never had any kind of serious injury previously, then suffered a left PTR late March playing football (aged 41 and put it down to LOTS of wear and tear whilst still attempting to play at 100mph) - have had lots of ups and downs since, the first 2 months were extremely tough (especially the first days after surgery) but now walking normally and basically trying to build up the quadriceps from nothing.

Pretty reasonable ROM I think, round about 110-120 degrees when pushing it, have recommenced basic gym stuff in the last 3 weeks or so - cycle, rower, cross trainer - knee feels odd right now during exercise and when flexing/stretching it out but I think this is due to trying to push on a bit to try and get some much needed cardio - no pain just discomfort which I think is due to the fitted wire but really not sure.

Any advice gratefully received!

Cheers, Steve

[John42]

Hi and welcome to the eclusive RPT club - As you are aware, you have sustained a very rare and serious injury, but you seem to be making good rehab progress.

Please let me have your e-mail address, and I will let you have a set of documents which I put together which explains in more detail about your injury and the rehab procedure.

Where do you live?

Best wishes

JohnK/ Manchester UK
Jkramrisch@aol.com